L. I. F. T.

LIFE  IN  FAIRBANKS  TOWNSHIP, INC.

L.I.F.T., Inc.     Membership Application

Membership type:       _____Family ($25.00/year)     _____ Adult  ($20.00/year)  _____ Youth  ($10.00/year)

(Please Print)

__________________________________    _________________________

First Name                                                         Last Name

_________________________________________         _______________________

Street Address                                                                        Mailing address (PO BOX)

_________________________________________              _______________________________

City,   State,    Zip                                                                  Home Phone

_________________________________________              ________________________________

Work Phone                                                                            Cell Phone

__________________________                    _____________________________________________________

County                                                                  Names of spouse & Children for family membership

E-Mail ________________________________________

How do you prefer to be contacted?  __________________________________________________________________

What type of activities interest you and your family?  ________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

General Release Form:

BE IT KNOWN, that the person(s) mentioned above with a legal residence listed above do hereby agree to indemnify and hold harmless, Life In Fairbanks Township, Incorporated / dba/ L.I.F. T., Inc.  (hereafter “L.I.F.T.”) and its officers, employees, and agents from any and all costs, claims, and damages of whatever nature, including but not limited to attorney’s fees, for injury or death to persons and damage to any real or personal property, resulting from or caused by, directly or indirectly, the use of the property, or the conduction of its events/programs.  Further, I do hereby remise, release, acquit, satisfy, and forever discharge L.I.F.T. and its officers, employees and agents from any and all manner of actions, causes of action, suits, debts, covenants, contracts, controversies, agreements, promises, claims and demands whatsoever, which I may ever have, now have, or which any personal representative, successor, heir, or assign, hereafter can, shall or may have by reason of any matter, cause or thing whatsoever.  It is my intention that this release will protect L.I.F.T. to the fullest extent possible under the laws of the State of Indiana regardless of the fault or causation of damage by L.I.F.T.

Signature: _________________________________________  Date :______________________________

Spouse Signature: ______________________________________  Date:___________________________

Subscribed and Sworn before me this ________ day of  ___________, 20 ____.

My Commission expires __________________________________ County of Residence:_______________

Notary Signature & Seal:____________________________________________________