IWFFA Membership Application (please print all information clearly)

(circle 2 or more categories) Women's (17 yr + older) / Juniors (13 - 16yr) / Girls (7 - 12 yr) / Coach / Manager / Official / Fan / International / U.S.

$20 for all membership categories / Mail Certified Check, or Money Order Payable to : IWFFA / Visa or Master Card Accepted for individual memberships (phone office IWFFA)

Name _________________________________Address ______________________________ City ____________ State / Province _________

Country ______________________Zip Code / Postal Code _____________________ Date of Birth (month / date / year) _____________

Phone (area / country code) Home (___) _________________ / Mobil (___)________________ / Work (____)_____________

E-mail (please very clearly) _________________________________ Team Name ____________________ Team Contact _________________

League ______________________ Field Location ________________ How did you find out about the IWFFA? __________________________

Waiver / Liability Release

I, the undersigned, have agreed to participate in the International Women's Flag Football Association (IWFFA) event & appear in a video / or photos produced by the IWFFA and it's assigns and licensees, in any manner in any media either alone or in a conjunction with any other material . I sign Release for year 2006 (initial here) ______

I hereby waive and release and agree to hold harmless the IWFFA from any and all claims damages, causes of action, suites and liability, of any kind for any personal injury, death or property damage which I may sustain arising out of or occasioned by my participation in the IWFFA activities. This waiver and release shall also be binding upon my spouse, partner, heirs, personal representatives and any other person who may claim through me. I sign agreement / waiver for year 2006 (initial here) ______

Signature ________________________________________ Date _______________________