CEDAR RAPIDS and IOWA CITY WALLEYE CLUB MEMBERSHIP/SPONSOR FORM & LIABILITY WAIVER

Name:

Address:

Email:

Phone:

Membership:
Adult ($20)Youth (under age 16) Free

Participation Level:
BoaterNon-Boater

Boat (Year/Make/Model):

Motor (Year/Make/Model):

Walleye Federation Member*:
YesNo

The undersigned applicant hereby indemnifies, releases and holds harmless the Cedar Rapids and Iowa City Walleye Club, its officers, directors, and agents as well as any persons, property owners, boat owners, boat operators, and/or sponsors from any and all liability or damages for injury to the undersigned applicant as a result of participation in any club activity. Further, said applicant agrees to reimburse any of the aforementioned parties for the cost of damages paid as a result of any action by the undersigned applicant or any person/entity representing and/or acting on said applicant’s behalf and to further reimburse and/or repay the legal costs associated with or arising out of damages sought by the undersigned applicant. Further, undersigned applicant releases and transfers all rights to the use and ownership of any imaging taken or used during CRANDIC Club events or business to the Club without restriction or reservation. By signing this application, the undersigned agrees to abide by all club rules and regulations and accepts all decisions by the club’s president, tournament director, and/or agents as a final decision without right of appeal.

Applicant’s Signature (Typed Name & Initials):

*if applying online then typed name followed by typed initials

Guardian’s Signature (if under 16):

*All youth members must have an accompanying guardian’s signature

Annual Dues: Adult-$20    Youth (16 & under) Free    Walleye Federation-$40*

Submit to: CRANDIC WALLEYE CLUB, P.O. BOX 291, Hiawatha, IA 52233 or dorkrigger@gmail.com

*Walleye logo courtesy of State Historical Society of Iowa and Iowa Department of Natural Resources. Artist: Maynard Reece.