Please read the document at this link in its entirety: "Release of All Claims and Agreement to Indemnify" and list two people below who may make decisions for you in case of emergency, prior to submitting this form.
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Your Name*
Your Email Address*
Your Address*
Your City*
Your State*
Your Zip Code*
Your Phone Number (No hyphens or parentheses, please)*
Alternate Phone/Cell Number
Family Names (if you are purchasing a family membership)
Emergency Contact Name*
Emergency Contact Phone*
Second Emergency Contact Name*
Second Emergency Contact Phone*
Release Signature: By clicking "I agree," you understand and agree to the entire "Release of All Claims and Agreement to Indemnify." Please click on the link and read it in its entirety before submitting. Clicking "I agree" is binding and equivalent to your signature. You must click "I agree" to become a member of LVMC. * I agree
I do NOT agree