Delorean Mid-Atlantic Club - Membership Form

DELOREAN MID-ATLANTIC CLUB

Please complete the application, print, and mail with your check (written out to 'DeLorean Mid-Atlantic Club') to:

Delorean Mid-Atlantic Club
c/o Justin Mettee
3838 Shaffers Church Road
Glen Rock, PA 17327

Member's Name
Spouse/Sig. Other
Street Address
City
State
Zip
Home Phone
Cell Phone
E-Mail
VIN
License Plate

RELEASE OF LIABILITY

The undersigned and their guests release DeLorean Mid-Atlantic and its officers and directors from any and all liability for loss or injury relating to an event sponsored by DeLorean Mid-Atlantic.

The undersigned and their guests release the sponsors of any DeLorean Mid-Atlantic activity from any and all liability for loss or injury.

The undersigned and their guests release DeLorean Mid-Atlantic, its officers and directors, and all of its members from any and all liability for advice and assistance in the maintenance of any automotive vehicle. All advice and assistance is used by the undersigned at his/her own risk.

The undersigned and their guests agree that participation in activities related to DeLorean Mid-Atlantic is at the risk of the undersigned and his/her guests.

Dated this____________day of ________________, 20____.

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Signature of Primary Member

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Signature of Spouse/Significant Other Member