British Columbia Medical Information & Release FormBritish Columbia Medical Information & Release FormBritish Columbia Medical Information & Release Form
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Disabled Sailing Association
of British Columbia, Victoria Branch
Membership Application Form
(Completion of this form also enrolls you as a member of the Victoria Integration Society).
Name: ________________________________________________________________
Address: ______________________________ Postal Code: ____________________
Phone: _______________ (home), ________________ (cell) email:_________________
Do you have a disability? _______ If yes, what is the nature of your disability? ___________

Specific requirements necessary based on nature of your disability: ____________________
_____________________________________________________________________
Membership Fee of $10.00 enclosed

___ cash___ cheque (payable to the Disabled
Sailing Association, Victoria Branch).

WAIVER OF LIABILITY
Please read and sign the waiver of liability below. You require a witness to also sign the waiver.
Disclaimer Clause:
The British Columbia Mobility Opportunities Society and the Disabled Sailing Ass