Your
contact information will be kept confidential.
Only new
memberships will receive a shirt.
Spouses
Information: Note: to qualify couple must reside at same address.
First Name:
Last Name:
Date
of Birth:
(MM-DD-YYYY)
E-mail:
Shirt selection:
Your
contact information will be kept confidential.
Only new
memberships will receive a shirt.
Contact Information:
Street Address:
City:
State:
Zip:
Home Phone:
Mobile Phone:
Other Information:
Interests/Hobbies/Activities
The Midwest BearPack encourages its members to handle
themselves in a safe and professional manner at all events and functions. The
Midwest BearPack is a social group of adult and mature individuals and does
not encourage unsafe or violent behavior of any kind. The Midwest BearPack
will not be held responsible for any damages or injuries in its activities. By
clicking 'Submit' below, I signify that I (and my spouse) am (are) 21 years of
age or older and I (and my spouse) release the Midwest BearPack and its
members of any and all liability pertaining to my participation in any Midwest
BearPack activities. When I attend the activities of the Midwest
Bearpack, I understand that it is my personal responsibility
to inform any photographers if I do not wish my picture taken or used in a
newsletter or on the web site.
Contact webmaster@bearpack.org
if you get any error message after clicking SUBMIT or if you do not
receive a confirmation email after clicking SUBMIT. Thank you!
