2016-2017 Membership Application
Humboldt Bay Mycological Society
The purpose of the Humboldt Bay Mycological Society is to promote the enjoyment and appreciation of wild mushrooms through study and the exchange of information. Everyone who has an interest in wild mushrooms is welcome to become a HBMS member. Members are entitled to:
* The HBMS newsletter
* Nine monthly HBMS meetings featuring guest speakers and local experts
* Free participation in HBMS walks
* Free participation in the Mushroom Fair
* Free participation in HBMS workshops
Name: ______Phone: ______
Address:______Email: ______
City:______Email2: ______
State:______Zip: ______
WHAT ARE YOUR AREAS OF INTEREST IN MUSHROOMS?
Identification Photography Ecology Walks
Cooking /preserving Art Cultivation Workshops
Toxicology Dyeing-textiles/wool
Other______
How many wild mushrooms do you think you could identify? ______
WE NEED YOUR HELP
We can enjoy Fungi and Friends, but it takes your participation to make it happen. Please select several things you would like to do, and check the appropriate boxes.
Forays Workshops and Projects
Lead walks Organize or lead
Assist leader Collect/assemble materials/supplies
Record list of fungi Set up/clean up
Monthly Club Meetings Club Business
Present a program Plan/organize events
Bring munchies Contribute to the newsletter
Set up/clean up Publicize meetings and events
Other ______
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Dues enclosed: $______
$15 Household, $12 Individual, or Lifetime ($185 hshld / $150 indiv)
Return completed signed and dated application and release form with check payable to HBMS to: HBMS, PO Box 4419, Arcata, CA 95518
PLEASE NOTE: Signing and dating the release form on the back is a
requirement for membership.
Humboldt Bay Mycological Society
2016/2017
Release and Indemnification Agreement
This Release and Indemnification Agreement (the "Agreement") is entered into by and between the Humboldt Bay Mycological Society, as it is presently organized and may be later structured ("HBMS") and the undersigned Member (the "Member") on this ____ day of ______, 2016/2017.
WHEREAS, HBMS is a non-profit educational organization that has as its principal purpose the sharing of
mushroom-related information among its members; and
WHEREAS, all officers, directors, identifiers and members serve HBMS in a voluntary capacity and receive no
remuneration for their services; and
WHEREAS, in cases where HBMS charges a fee for its forays, walks, lectures and other events (collectively
" HBMS Events"), it is doing so only to cover its direct costs and does not operate in a for-profit capacity; and
WHEREAS, the Member understands that there is inherent and unavoidable risk in outdoor activities relating to
hunting and consuming wild mushrooms. These risks include but are not limited to the dangers of hiking in
difficult terrain, the possibility of misidentifying a wild mushroom, and the possible allergic or toxic reaction that
some individuals may have to otherwise edible mushrooms.
NOW THEREFORE, the Member hereby agrees to the following:
1. The Member assumes all risks associated with HBMS Events. The Member expressly acknowledges that it is the Member's sole responsibility to hike safely and to determine whether a wild mushroom may be consumed.
2. The Member releases, holds harmless, and indemnifies HBMS, its officers, directors, identifiers, and representatives from any and all liability relating to any injury or illness incurred by the Member or the Member's family members as a result of participation in a HBMS Event.
This Agreement shall be governed by the laws of the State of California. If any portion of the Agreement is declared for any reason to be invalid or unenforceable, such invalidity shall not affect any other provision of the Agreement. This Agreement shall apply to all HBMS events for the calendar years 2016/2017.
MEMBERS:
SignaturePlease print name
(if Participant is under age 21, signature of Parent or guardian)
1 ______1 ______
2 ______2 ______
3 ______3 ______
4 ______4 ______
Date signed :______