Oregon RVing Women - Membership Form

www.oregonrvingwomen.org

Oregon Chapter of RVing Women
2012 Dues and/or Membership
(Membership year is January 1 – December 31)

National RVW Expiration Date:
Name #1:		Birthday (Mo & Day)
Name #2		Birthday (Mo & Day)
Mailing Address:		City, State, ZIP
Phone:		Cell Phone 1:
		Cell Phone 2:
Email Address For Name 1:
Email Address For Name 2:
Type of RV *			RV Length:
RV License #:	How many Slide outs?
Towed or Towing Vehicle:	License # for Vehicle:

*Motor home, 5^th wheel, travel trailer, van, truck, camper, tent

Oregon Chapter of RVing Women Dues

Annual Dues are $5.00 per person.

Membership Dues ($5.00 per person)	$
$5.00 New membership processing fee:	$
(This is a one time fee for each new member) Donation to ORVW (not tax deductible)	$
Total (US funds only) -----	$

Please send this form with your payment (Checks payable to ORVW) and corrections to:

June Willoughby, 1101 Fulton Ave, Coos Bay, OR 97420
Phone: 541-888-9634, email: rthrbgolfn@charter.net

Event Disclaimer

Your registration indicates your knowledge and agreement that you assume all risks attendant to your participation in all ORVW events (including optional side trips) operated by or under the control of Oregon RVing Women and hereby waive, release and forever discharge OR RVing Women, and any of its officers, employees, agents, successors and assignees, from any and all claims or actions of any kind for personal injuries and/or property damage which you may cause or sustain during these events or during travel to and from these events. This further confirms your agreement to pay any and all costs, including reasonable attorneys’ fees, that may be incurred by the above entities as a result of any such claim by you or your agents and further acknowledges your sole responsibility for your personal safety, possessions (including pets), equipment and vehicles during these events and related activities. This waiver and release is to be controlled by Oregon Law.

In addition, by attending these events, you irrevocably and unconditionally consent to being photographed and recorded, including being videotaped, and to having your voice, likeness, identification and actions used in any and all media without restriction. Recording and use will be made in reliance on the consent evidenced by your attendance at these events. If for any reason you do not consent as herein provided, you are responsible for notifying the photographers and/or video recorders.

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Signature Date

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Signature

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