ARKANSAS CATFISHING ASSOCIATION (ACA) (Registered)

MEMBERSHIP APPLICATION/REGISTRATION – 2008

 ( Regular Annual Dues $20 – Associate No Dues )

(Please print) 

Full Name: ________________________________________________

Address:   ________________________________________________

City: ________________________ State: ___ ZIP: ______-_____

Phones (include area code)  Daytime: (____) ______-_________

Nights (____) ______-_________ Cell: (____) ______-_________ 

Email(s): __________________________________________________

___Yes, I have access to the internet, and will access the ACA website when online.

___No, I do not have access to the internet (neither personal, relative nor a friend).  NOTE: If relative or friend, ensure their approval.

___Yes, include my address and phone number and/or email address on the association roster and on the ACA’s secured membership section at the ACA’s website when online.

___No, do not include my address and phone number and/or email address on the association roster or the website.

WAIVER/RELEASE FROM HARM:  In consideration of your acceptance of my application, I for myself, my heirs, my executors and my administrators, hereby release and hold harmless and forever discharge the Arkansas Catfish Association (ACA), their servants, agents, representatives, successors, assignees, hosts, sponsors, event officials, other event participants and the Arkansas Game and Fish Commission from any and all claims for personal injury, death, dismemberment or property damage which I may experience during the course of the events for the entire year of 2008.  I also agree to abide by the event rules and Arkansas State Laws, including all Arkansas Boating Regulations for the duration of all events for the year 2008. I further understand that temporary membership is valid for 30 days and unless disapproved for any reason, becomes permanent after one (1) month, but in the interim I’m considered a regular member with all rights and privileges (Art II Members, Sec 5, Bylaws).  I have received or will be provided, a copy of the Constitution and Bylaws.

Signature: _____________________________   Date: _____________________

Approved:  _____________________________   Membership #:   ___________
             Member, Board of Officers

Make Checks/M.O.Payable to: Arkansas Catfishing Association ACA      
Mail to:  Arkansas Catfishing Association (ACA), PO Box 872,
          Pocahontas AR 72455