WESTERN KENTUCKY BASS CLUB

LIABILTY RELEASE FORM

For Members and Guest

Liability Release: In signing this agreement, I hereby release Western Kentucky Bass Club, its officers, sponsors, agents, any of its members, from any and all damages, claims, thefts, demands, cost, accidents or expenses relating to injury of any persons or damage to any property which I may cause by reason of participating in or in connection with any Western Kentucky Bass Club Tournament Fishing event.

Covenant Not To Sue and Waiver of Subrogation: I further agree that I will never sue Western Kentucky Bass Club, or any of its members for damages on account of any injury damage that I suffer or cause whether known now or which may develop in the future in connection with this or any other Western Kentucky Bass Club tournament fishing event. I expressly agree to indemnify and hold Western Kentucky Bass Club and its members harmless from any liability whatsoever, including court cost and attorney’s fees arising with respect to such action. I understand that in waiving my rights to sue Western Kentucky Bass Club or any of its members, I am waiving the right to recovery from Western Kentucky Bass Club or any of its members, of my insurance carrier for any claims they may pay on my behalf. I further understand that by signing this agreement, I waive any rights my heirs or relatives have or may have to sue Western Kentucky Bass Club or any of its members for liability.

Construction: If this agreement and the release, covenant, and waivers contained herein are found by any court to be overly broad in any manner, I ask the court to interpret it as broadly as possible.

Reading and Understanding: I signify by my signature that I have read and understand the above agreement and all Western Kentucky Bass Club Rules.

Club Fee is $50.00 and includes a WKBC T-shirt. Please sign & fill out your shirt information below. Any additional shirts are $15.00 each. Any former member wanting to purchase an additional shirt (s) should be paid along with your membership dues by February 28th.

Partner 1                                                                 Partner 2 or Guest

 

Name: ____________________________                        Name: ___________________________

 

Address: __________________________                         Address: __________________________

 

City: __________________ St. ________                         City: _________________ St. _________

 

Cell # ­­­____________________________                          Cell # ____________________________

 

Sign & Date: ____________ ________ Sign & Date: ______________________

 

T-shirt Size: _____________ T-shirt Size:  _____________

Cotton or Dry Fit                                                         Cotton or Dry Fit

Pocket Yes or No                                                         Pocket Yes or No

 

T-shirt Size: _____________ T-shirt Size:  _____________

Cotton or Dry Fit                                                         Cotton or Dry Fit

Pocket Yes or No                                                         Pocket Yes or No

 

T-shirt Size: _____________ T-shirt Size:  _____________

Cotton or Dry Fit                                                         Cotton or Dry Fit

Pocket Yes or No                                                         Pocket Yes or No

 

*Pockets are available on Cotton only*

 

Mail to:                                    Make checks payable to Western Kentucky Bass Club

Marvin Wayne Wells

722 Peach Orchard Rd.

Lewisburg, KY 42256

Last Updated (Sunday, 01 January 2017 08:29)