CASKA

Membership/Renewal Application

Make check payable to:   CASKA
Mail check and completed application form including signed ACA waiver(s) to:

Gary Mechanic
CASKA Treasurer
27947 N Ash
Wauconda, IL 60084

PLEASE READ AND SIGN THE FOLLOWING WAIVER:

    I agree that I will take part in CASKA (an ACA Paddle America Club) activities at my own risk.  I will not hold CASKA, its officers, trip leaders, and/or members responsible for any injuries or property damage that I or any member of my family may incur while participating in club activities.  I am 21 years old or older.

Signature:___________________________________________   Date:_____________________ ACA Membership # ___________________________

Please Print:
Last Name:___________________________________   First Name:_______________________

Street Address:_________________________________________________________________

City:______________________________________ State:______ Zip:_____________________

Phone:_____________________    E-Mail:____________________________________________

Please check all that apply:

____Membership renewal? ____New membership? ____Change of Address?

_____ $12.50 Individual CASKA membership

_____ $18.00 Family CASKA membership

You may publish my name in the member directory: ____Yes  ____No

You may publish my email address in the annual directory: ____Yes ___No

You may publish my address and phone information in the member directory: ____ Yes ____ No