Sierra Vista
Dart Association
Membership Application
Name: ______________________________

Address: _____________________________

City:________________, AZ   Zip: ________

Home Phone:_________________________

Work Phone: _________________________

Team Name: _________________________

Email Address: _______________________

Birthday: ____________________________
The undersigned does hereby forever release the Sierra Vista Dart Association from any and all claims for injury (and any loss based on such injury )that has heretofore accrued or may hereafter accrue to the undersigned, his or her heirs, administrators, and or representatives.  I also hereby claim that I am 21 years of age or older which abides by the Sierra Vista Dart Association rules.

             Dated this ___________day of _____________, 200__.
          
               _______________________________________
                                     Member

              _ ______________________________________
                                     Witness

November 12, 2002