Pittsburgh Ski Club – Membership Application Form

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Official PSC Use Only: Member No. Amt. Received: $ Cash Check No.

2011–2012 PITTSBURGH SKI CLUB Membership Application

NEW THIS YEAR – Pay your membership dues online using

(No PayPal account is needed)

OR just print this application and mail it in along with your check.

Membership for:

Type of Membership:

All Fields Preceded by an Asterisk (*) are required *Date:

*Last Name:      *First Name:      Birth Year:

*Street Address:

*City:     *State:     *Zipcode: –

Home Phone:     Work Phone:     Cell Phone:

E–mail Address (for newsletter delivery):

*Type of Member:    New Member     Renewing Member

*Type of Skier:   Downhill Skier     Cross Country Skier     Snowboarder     Want to learn     Non–Skier

Check this box if you DO NOT want to be listed in our annual membership directory.

Check this box if you want your newsletter by U.S. mail instead of e–mail for an additional $10/year.

If you wish to serve on any of the club committees, select the appropriate check box(s) below:
Program      Travel      Publicity      Membership      Hospitality      Racing

OTHERS IN THE SAME HOUSEHOLD JOINING

Last Name:      First Name:      Birth Year:

Last Name:      First Name:      Birth Year:

Last Name:      First Name:      Birth Year:

Processing the application

Annual Dues for adults 21 and over are $25. Additional adults at the same address are $15 each. Children under 21, with adult at same address, are $10 each. Memberships will be effective until May 31, 2011. The PSC By–Laws require that membership privileges be terminated unless renewal dues are received by July 31^st.

To process your membership, do the following:

Complete the application form with up to 4 people (from the same household).
Type in the two distorted words that are above the buttons below
OR click the speaker symbol and type in the voice challenge that you hear.
Press the “Submit” button below. When submitted successfully, a PayPal online payment option will display.
Press the “Print” button below and sign the application form, if mailing in.
Send your completed and signed form(s) and a check for the required amount to:
PSC Membership, P.O. Box 2022, Pittsburgh, PA. 15230

*As a PSC Member, I waive any clain against the non–profit organization known as the Pittsburgh Ski Club, its board of directors, and individual trip or event leaders for personal injury, death or property loss directly relating to trips or activities held by the Pittsburgh Ski Club. (please check to indicate agreement).

Signature (Parent/Guardian, if under 21)

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P.O. Box 2022, Pittsburgh, PA. 15230