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Malta Boat Club 9 Boathouse Row Philadelphia, PA 19130 Membership Application Personal Information Full Name: Date: Last First M.I. Mailing Address: Street Address Apartment/Unit # City State ZIP Code Permanent Address (if different): Street Address Apartment/Unit # City State ZIP Code Phone: Email Date of Birth/Age: / Weight: Height: Education/Professional information High School: College/University: Employer: Job Title: Years with Employer: Self-History: (What are you studying in school? What do you do for a living? What hobbies do you have?) Rowing Information Rowing Experience: YES / NO Number of Years: Sweep / Scull / Both Club(s): Reason for Leaving: Please circle your skill level in each boat classification: 1X: Novice/None Junior Intermediate Senior/Elite 2X: Novice/None Junior Intermediate Senior/Elite 4X: Novice/None Junior Intermediate Senior/Elite 1 Promise of Membership I hereby apply for membership in Malta Boat Club. If elected membership, I agree to be governed by the provisions of the by- laws and by the rules and regulations of the Malta Boat Club. I hereby exonerate myself and hold blameless the Malta Boat Club, its officers and members both for myself and those who may take over my affairs from any liability for any injuries to myself, even fatal, which may occur in connection with my activities from the club or at the club as a result of my membership in the club. I further promise to repay the club the cost of repairing or replacing any of its equipment damaged or destroyed as a result of my negligence. I include $____________ as required to accompany this application. As a sponsor, I agree to review club rules and regulations with the applicant, evaluate their rowing ability (100 miles), and introduce the new member to the club facilities. Sponsor: If the applicant is a minor, consent and approval of parent or legal guardian, including acceptance of the above waiver of liability must be given. I hereby attest that I have read this application and agree to abide by all rules and provisions of the Malta Boat Club, including acceptance of above waiver of liability. I further affirm that all information given on this application is truthful, to the best of my knowledge. Applicant Signature: Date: Parent/Legal Guardian Signature: Date: Important: All new applicants must be interviewed by at least two new members of the membership committee. Their names and sponsors must then appear in the monthly newsletter for review by the general membership. If there are no objections, the applicant will be accepted for membership at the next scheduled membership meeting. 2 .

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