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(307) 221-0991 Keith Henderson
Climbingadventuresofcheyenne.com
[email protected]
Membership Agreement
PARTICIPANT’S INFORMATION – PLEASE PRINT CLEARLY
Name______________________________________Phone#___________________________
Address____________________________________Date of Birth______/______/__________
City__________________ State____ Zip________ Emergency #_______________________
Today’s date _____/______/_________
MEMBERSHIP JOIN FEE: ________________ MONTHLY DUES PAYMENT_____________
FAMILY MEMBERSHIP JOIN FEE_________ MONTHLY DUES PAYMENT______________
FAMILY MEMBER _______________________ SIGNATURE_____________________________
FAMILY MEMBER _______________________ SIGNATURE_____________________________
FAMILY MEMBER_______________________ SIGNATURE______________________________
I HEREBY AUTHORIZE CLIMBING ADVENTURES-LLC (HEREBY REFERRED TO AS CLIMBING ADVENTURES) TO
AUTOMATICALLY RENEW MY MONTHLY CONTRACT ON A MONTH-TO-MONTH BASIS WHICH BECOMES
EFFECTIVE ON THE THIRTY-FIRST DAY FROM MY JOIN DATE. I AGREE, AUTHORIZE AND DIRECT CLIMBING
ADVENTURES TO RENEW THIS CONTRACT ON A MONTH TO MONTH BASIS AND FURTHER DIRECT
CLIMBING ADVENTURES TO CONTINUE TO DEBIT MY CREDIT CARD, BANK ACCOUNT, OR INVOICE ME FOR
MONTHLY DUES OR ANY OTHER FEESAND CHARGES AUTHORIZEDIN THIS CONTRACT. I ALSO
UNDERSTAND THAT ORAL CANCELLATION WILL NOT BE VALID. I MUST RETURN MEMBERSHIP CARD WITH
WRITTEN NOTICE OF CANCELLATION. I ALSO AGREE TO GIVE TO GIVE THIRTY DAYS WRITTEN NOTICE OF
CANCELLITION EFFECTIVE AFTER THE NINITY-FIRST DAY FROM JOIN DATE HAS BEEN COMPLETED. I
ACKNOWLEDGE THAT I AM LIABLE FOR ALL FEES AND CHARGES UNTIL THE THIRTY DAYS FROM THE NEXT
BILLING DATE AND AGREE TO PAY ALL CHARGES FEES AND PAYMENTS PROVIDED IN THIS CONTRACT.
JOIN DATE_____________________MEMBER SIGNATURE_____________________
WAVIVER AND RELEASE OF LIABILITY: Members understand that the agreement to
employ Climbing Adventures to train and guide in outdoor activities shall be the members sole
responsibility. Climbing Adventures shall not be held liable to member for any injuries demands,
claims, actions, or damages arising from injury to member’s person or property in connection with Climbing Adventures activities that may be brought against them by members or on members
behalf for any such claims or injuries. All members agree to sign the Assumption of Risk form as
part of membership.
CLIMBING ADVENTURES RIGHTS TO SUSPEND OR CANCEL: Climbing Adventures
hereby reserves the right to cancel or suspend this membership in its sole discretion. Member
agrees to pay a $10.00 fee for each replacement card.
ASSUMPTION OF RISK: Members may cancel this agreement 90 days after the date of this
agreement excluding holidays and weekends. To cancel this agreement fax, mail or deliver a dated
and signed notice which states that you the member are cancelling this agreement. Such notice
should be sent to Climbing Adventures 249 Shoshoni Street Cheyenne Wyoming 82009.
BINDING ARBITRATION: If any dispute arises on an interpretation of the rights and
obligations under this Contract, each party agrees to submit the matter to arbitration in accordance
with the commercial arbitration rules of Judicial Arbitration and Mediation Services unless parties
agree otherwise. Any award made by the arbitrator will be final and binding and may be entered
as a judgment in any court having jurisdiction. The prevailing party will be awarded all costs of
arbitration including reasonable attorney’s fees.
MEMBERSHIP: This membership is absolutely not transferable and member may not assign,
transfer, or sell this agreement, his or her membership card, or membership in Climbing
Adventures, or any other privilege or right, and any such attempted assignment, transfer or sale
shall be null and void. Member may not loan his or her membership card to anyone. NO ORAL
CHANGES OR CANCELLATIONS ARE PERMITTED. NO CHANGES TO THIS
STATEMENT ARE PERMITTED. MEMBER VERIFIES THAT NO ORAL PROMISES
OR ANY OTHER PRIVILEGES OR REPRESENTATIONS HAVE BEEN MADE AND
THAT THIS WRITTEN CONTRACT IS THE AGREEMENT IN FULL
CREDIT / DEBIT CARD
CREDIT CARD (CIRCLE): VISA MASTERCARD CARD NUUBER: ________________
NAME ON CARD______________EXP DATE___________ VERIFICATION#___________
BILLING
ADDRESS___________________________CITY_________STATE_____ZIP____________
This authorization is to remain in force until Climbing Adventures has received written
cancellation from me. Member authorizes Climbing Adventures to dedit the account for all sums
owing Climbing Adventures including but not limited to membership dues and all taxes enacted
by the state of Wyoming or any governing authority.
MEMBER SIGNATURE X_____________________________________________________
MEMBER NAME (PRINT)__________________________________ DATE_____________