____ Renewal____New
Membership____New Address
Name________________________ Date of Birth_____________
Address__________________________
City_________________
USMS Reg. #_____________________
State_____ Zip________
Age____ Sex____ Phone
(H)_____________(W)_____________
Email_________________________
**YOU MUST ALSO REGISTER WITH ILMSA**
Make check payable to Chicago Masters Swim Club
I, the undersigned
participant, intending to be legally bound, hereby certify that I am physically
fit and have not been otherwise informed by a physician. I acknowledge that I
am aware of the risks inherent in Masters Swimming (training) and competition,
including possible permanent disability or death and agree to assume all of
these risks. I hereby waive any and all
rights to claims for loss or damage arising out of the participation in the
Chicago Masters Swim Club and any activities incident to membership thereto
against U. S. Masters, Inc., Central Masters Swim Association, Chicago Masters
Swim Club, the Chicago Park District, the Trustees of the University of
Illinois, the University of Illinois at Chicago, their respective officers,
agents and representatives, for any and all damages which may be suffered by me
in connection with my association with or participation in any way with the
Chicago Masters Swim Club and any of its sanctioned or approved activities.
Signature_________________________
Date_____________