Team Cobras Membership Application

Applicant First Name

Applicant Last Name

Gender

Birthdate

Contact Email

Contact Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Emergency Contact First Name

Emergency Contact Last Name

Emergency Phone

Relationship to Member

Details Payment Phone

Membership Type

Reasons for Joining the Club

Referred By (if applicable)

First

Last

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I have carefully read the preceding and understand its terms. I understand that I am giving up substantial rights, including my right to sue Releasees as set forth above. I acknowledge that I am signing this Agreement freely and voluntarily. I intend my electronic or handwritten signature to be a complete and unconditional release of all liability to the greatest extent permitted by law.

Signature

Clear Signature

Agreement

I have read and agree to the club rules and code of conduct. I understand that failure to follow club rules may result in termination from the club.

Date of Application

Credit Card

Adult or junior

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