PREMIER 50 EVENTS & TRAVEL
Liability Release Form

 

You have requested a reservation on a Venture Bank's Premier 50 Club trip and you could be subject to personal injury.

 

To participate, please sign and return this form with your signed registration form and check prior to your trip, to release and indemnify Venture Bank, its employees and stockholders from liability. You may drop off this form at any Venture Bank Financial Center, or mail to: Premier 50 Club, Venture Bank, Attn.: McKim Odom, PO Box 970, DuPont, WA 98327.

 

I HEREBY HOLD VENTURE BANK, ITS EMPLOYEES AND STOCKHOLDERS HARMLESS, ON BEHALF OF MYSELF AND MY HEIRS AND ASSIGNS, AGAINST ANY AND ALL CLAIMS, LIABILITIES, AND COSTS (INCLUDING REASONABLE ATTORNEY FEES AND WHETHER BY REASON OF PERSONAL INJURY OR DEATH OR PROPERTY DAMAGE OR OTHERWISE) ARISING OUT OF OUR CONNECTION TO THIS ACTIVITY.

 

TRIP: Islands of New England
TRAVEL DATE: Oct. 3-10 , 2008

 
PASSENGER #1: ____________________________________________ (please print name)

 
__________________________________________
SIGNATURE OF WAIVER OF LIABILITY		   ________________________
DATE
 
PASSENGER #2: ____________________________________________ (please print name)

 
__________________________________________
SIGNATURE OF WAIVER OF LIABILITY		   ________________________
DATE
 
PASSENGER #3: ____________________________________________ (please print name)

 
__________________________________________
SIGNATURE OF WAIVER OF LIABILITY		   ________________________
DATE
 

 

MUST BE ATTACHED: ___  REGISTRATION FORM ___ CHECK/M.O. (if pay by check)