Name      Date

  Address

City   State       Zip

  Phone (Home)      Phone (Work)

   Email Address

  Fax   

Name of Family Members Joining

    I understand (as an individual or as a representative of my family) that a certain amount of risk is involved in hiking and related activities, and I agree (as an individual or family representative) I will not hold TAKAHIK, River Valley Hikers (a club), its officers, other members, or group leaders, responsible for any injuries I (or those I represent) may incur while taking part in activities sponsored by said club.

SIGNED ______________________________     DATE ________________   

          Type in information, print out page 1 of 2, sign and mail with your check to: TAKAHIK, River Valley Hikers, 608 West B Street, Russellville, AR 72801.

Note:  Membership renewal October of each year,