Membership Application

LAS VEGAS MOUNTAINEERS CLUB MEMBERSHIP FORM
Please read the document at this link in its entirety: "Release of All Claims and Agreement to Indemnify" and list two people below who may make decisions for you in case of emergency, prior to submitting this form. All starred * fields are required.
*For renewing members: When renewing online, you must fill out all starred fields so that we may verify that your information is current. Thank you.**
	Name	*
	Street Address	*
	City	*
	State	*
	Zip Code	*
	Phone (No hyphens or parentheses please)	*
	Alternate Phone/Cell
	Email Address
	Family Names (for family memberships)
	May we list your phone number on our members-only LVMC email and phone number list (password-protected at lvmc.org)?	Yes No *
	Emergency Contact Name	*
	Emergency Contact Phone	*
	Emergency Contact Alternate Phone/Cell
	Emergency Contact Street Address
	City, State, Zip Code
	Second Emergency Contact Name	*
	Second Emergency Contact Phone	*
	Second Emergency Contact Alternate Phone/Cell
	Second Emergency Contact Street Address
	Second Emergency Contact City, State, Zip Code
	Release Signature: By clicking "I agree," you understand and agree to the entire "Release of All Claims and Agreement to Indemnify." Please click on the link and read it in its entirety before submitting. Clicking "I agree" is binding and equivalent to your legal signature. You must click "I agree" to become a member of LVMC.	I agree I do NOT agree *