PO Box 536
ELTHAM VIC 3095
Affiliated with Bushwalking Victoria
WEBSITE:
PROSPECTIVE MEMBER REGISTRATION
Prior to first qualifying walk please complete and hand to new member contact person at the induction meeting at 7.30 pm prior to a regular monthly club meeting. The registration fee is $10. If unable to attend the meeting then post this form with your payment or indicate payment made via EFT (details below): The Secretary, Diamond Valley Bushwalking Club - P.O. Box 536 Eltham VIC 3095.
Surname: / First name: / M or F / Date of Birth: / / /Address: / Postcode:
P.O. Box (for mailing): / P.O. Box Suburb: / Postcode:
Email address:
Phone(H): / ______/ Phone(W): / Phone(M):
An Information slip should be carried by all walkers listing medical information and emergency contact details of relatives that might be required in an emergency.
CLUB PARTICIPATION
As the club depends on volunteers, after 12 months membership you are encouraged to help your club by leading a walk or assisting with club organisation/administration.
ACKNOWLEDGEMENT OF RISKS AND OBLIGATIONS
This acknowledgement applies to all activities I may undertake as a member of the Diamond Valley Bushwalking Club [the Club]. In voluntarily participating in activities of the Club, which are described to me by the Activity Leader I am aware that my participation in the activities may expose me to hazards and risks that could lead to injury, illness or death or to loss of or damage to my property. I also acknowledge that I may encounter weather conditions that could lead to hypothermia and being in locations where evacuation for medical treatment may take hours or days. In particular when participating in abseiling or above the snowline activities I am aware that these activities could expose me to additional hazards and risks described to me by the activity leader.
To minimise risks I will endeavour to ensure that:
1. each activity is within my capabilities; and
2. I am carrying food, water and equipment appropriate for the activity. In addition I will:
a)advise the Activity Leader if I am taking any medication or have any physical or other limitation that might affect my participation in the activity;
b)make every effort to remain with the rest of the party during the activity;
c) advise the Activity Leader of any concerns I am having; and
d) comply with all reasonable instructions of Club Officers and the Activity Leader.
I have read and understand the above requirements,. I have considered the risks before choosing to sign this Ackowledgement of Risks and I still wish to join the activities of the Club. I acknowledge that I will take responsibility for my own actions and that signing this form OR the payment of my subscription will be deemed as full understanding and acceptance of the above conditions.
Signature: / Date:I first heard about Diamond Valley Bushwalking Club from
Friends / Web / Bushwalking Victoria / Other source (please specify):Payment Details:Diamond Valley Bushwalking Club Inc. has adopted a non smoking policy.
By Electronic Funds Transfer (EFT)
Account Name: Diamond Valley Bushwalking Club
BSB: 083-232
Account: 02 761 5451
Reference: ‘Your Surname’ Pros Mbr
Official use only: / Payment received / Yes/No / Receipt No:Information forwarded / Yes/No / Date:
Record entered / Yes/No / Date:
26 September 2017 Form 2_DVBC_ProspectiveMemberRegistration.doc