Application for Membership

Application for Membership, including Liability Waiver

Membership is restricted to retired or semi-retired men and women over the age of 55.
A spouse/partner (under 55) of an eligible member may also apply for membership. Both may apply at
the same time. Effective April 1st, 2019, annual dues are $50/person for new members (includes membership badge) & $35/member for annual renewals. Membership applications completed between April 1 and May 31
will be valid until renewal on June 1 the following year. The Application Form may be completed online, or downloaded, printed and completed. Forms and/or
cheques to be mailed to;
Glacier Probus Club,
PO Box 3592,
Courtenay, BC V9N 6Z8

When the Membership Application and payment have been processed, the new member will receive an invitation to visit the Activity Groups Directory webpage and sign up for Activity Groups.

Each person requesting membership must complete a separate Application form. If you prefer to download the application form and complete the process manually, skip this next Online Application for Membership section and continue with Manual Application for Membership.

Online Application for Membership
Remember to click the Submit button at the bottom:

* Indicates required field

Full Name, First and Last: *

First

Last

Email Address: *

Full Mailing Address: Street, City, and Postal Code *

Telephone Number: *

Volunteer and work experience *

Year of Birth *

CONTACT INFORMATION IN CASE OF EMERGENCY
Contact information is required in case of accident or illness when participating in a Glacier Probus Club Activity. Cell phone numbers are preferred as in general people can be contacted more readily. This information will be stored in the club’s private contact list and will only be used in case of emergency. Should your contact details change over time, please provide updated contact information. The club encourages you to carry your contact information with you.

Contact infromation:

Primary *

First

Last

Phone Number *

Second *

First

Last

Phone Number *

RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT
PLEASE READ CAREFULLY! BY SIGNING THIS DOCUMENT YOU WILL WAIVE CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE OR CLAIM COMPENSATION FOLLOWING AN ACCIDENT.

IN CONSIDERATION of being permitted to compete, officiate, observe or participate in any way in the events organized or sponsored by Glacier Probus Club No. 228, which events may include but are not limited to snowshoeing, hiking, biking and dancing (all of which are collectively referred to as the “Events”), and for other good and valuable consideration, the receipt and sufficiency of which is acknowledged, I, the undersigned, for and on behalf of myself, my heirs, executors, administrators, next of kin and assigns, HEREBY:

ACKNOWLEDGE that the Events involve inherent RISKS, DANGERS AND HAZARDS which may cause BODILY INJURY and/or DEATH and/or PROPERTY DAMAGE;
WAIVE any and all claims that I may have against Glacier Probus Club No. 228, Probus Canada, and each of them, their directors, officers, employees, servants, members, representatives or agents (all of whom are collectively referred to as the “Releasees”);
RELEASE the Releasees, from any and all liability for any loss, damage, expense or injury, including death, that I may suffer arising out of or related to the Events or as a result of my participation in the Events due to any cause whatsoever, including negligence, breach of contract, or breach of any statutory or other duty of care, on the part of the Releasees, and further including the failure on the part of the Releasees to take reasonable steps to safeguard or protect me from the risks, dangers and hazards of participating in the Events;
ASSUME FULL RESPONSIBILITY FOR ANY RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE that I may suffer arising out of or related to the Events or as a result of my participation in the Events whether caused by the negligence of the Releasees or otherwise; and waive notice of all Risks, Dangers, Hazards and Conditions in or about the Events;
AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS the Releasees and each of them from any loss, liability, damage or costs as they may incur as a result of my participation in the Events WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE; and
AGREE that this Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement is intended to be as broad and inclusive as is permitted by the laws of the Province of British Columbia, and that if any portion thereof is held invalid, the balance shall, notwithstanding, continue in full legal force and effect.

I have read this Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement prior to signing it, fully understand its terms, and understand that by signing it I am affecting the legal rights and liabilities of myself, my heirs, next of kin, executors, administrators and assigns in relation to the Releasees.
I ACKNOWLEDGE THAT I AM SIGNING THIS AGREEMENT FREELY AND VOLUNTARILY WITHOUT INDUCEMENT, REPRESENTATION, ASSURANCE, OR GUARANTEE BEING MADE, AND INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.

Online Pay Option invoice: All online applicants will receive a Glacier Probus Club Invoice via the email address supplied.
- Invoices can be paid by mailing a cheque to the address and for the amount shown at the top of this webpage.
- Invoices can also be paid online using a credit card, debit card, or bank account (plus a small service charge).

Prospective Member Acknowlegement: *

I have read and agree with all terms and conditions shown above: Click on the Submit button below when the form has been completed.

Submit

Manual Application for Membership:

The Glacier PROBUS Club Membership Application Form can be downloaded to your computer and printed. The application form is available in either Adobe pdf format or in MicroSoft Word format. Click on the pdf version Download File to open in a new Window and print directly from there, or click on the .doc version Download File and the document will download to your computer, where you can then print it out. Be sure to print one Application for each person, attach a cheque for $50/person made out to the Glacier PROBUS Club, and sign the form under the Waiver of Liability.

2020_application_for_membership_waiver_contact.pdf
File Size:	158 kb
File Type:	pdf

Download File

2020_application_for_membership_waiver_contact.doc
File Size:	35 kb
File Type:	doc

Download File

Quick link - Application for Membership