Member Signup Form

 Yes, I want to become a member of the Heber Valley Pickleball Club and play

one of America’s fastest growing sports enjoyed by all ages!

Name____________________________________________________________________________

Address __________________________________________________________________________

City ____________________________   State _____    ZIP________ Phone____________________

 Email_________________________________________________

I would be interested in serving on a committee or helping the Club with the following:

________________________Social events and activities

________________________Clinics

________________________Other Training Opportunities

________________________Fundraising Efforts

________________________Publicity

________________________Community Outreach

 Annual fee of $15 payable every January 1. If join after June 1^st, $10. Social member $10.

Mail check, payable to Heber Valley Pickleball Club, and completed form to: 

                Carlos Monssen
                1143 W Sunburst Lane
                Midway, UT 84049

For more information, call Carlos at 801-358-9786 or email carlosmonssen@msn.com.

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I hereby release and discharge the Heber Valley Pickleball Club and its officers from any and all actions, causes of action, claims and demands for, upon, or by reason of any damage, loss, personal injury or death which may result from or in connection with my participation of any nature in any of the Heber Valley Pickleball Club activities.  I understand that this release is binding upon myself, my assigns, my personal representatives & heirs.

Signature ___________________________________________________   Date ________________

If under age 18, Guardian Signature ______________________________________________________