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Member Registration

   Green Country Bears official OkEq program    

The Green Country Bears and its officers respects the privacy of its members. The Board of Directors will only use the information that you provide below to maintain records of our membership and to keep you informed about Green Country Bears events and related information.

Please provide us complete information so that we can maintain accurate records.
Membership: $20 year    Associate Mbr (no dues)   Full Member   Renewal        
Member Information I am interested in volunteering to assist with:
Name:
   Club Events   News Letter   Administrative
Home Phone Number
  Commities   Charity Events   Movie Nights
Cell Phone Number
  Party Hosting   Fundraising   Dinner Nights
Email
Member Privacy

The Green Country Bears respect the privacy of everyone. We usually take photos at our events to share on our website and on facebook.

Birthday
  Do Not Put Photos on Website   Do Not Put Photos on Facebook
Hobbies
To help us protect your privacy please inform any photographers if you do not wish your photo taken.
Street Address
City
State
Zip  
Domestic Partner:
Name:  
Email:  
 Birthday:  
Children (including Four Legged)
 
Name
Pet Breed
 Birthday
Release:
I offer my affidavit by electronic signature (act of entering the electronic code and submitting this application) that I am at least 21 years of age or older and I consent to the membership with the Green Country Bears and agree to abide by the Constituation and Bylaws of the organization, a copy of which I have been advised is available on www.greencountrybears.net or by hardcopy, upon request.
I understand and agree that I will not now or at any time during my membership in the organization hold the Green Country Bears, its directors, members or any other entity associated with the Green Country Bears liable for any type of injury, physical or otherwise, which I may sustain as a result of my involvement with the Green Country Bears. I assume total responsibility for my personal actions.

Electronic Signature ______________________________ Date: ____ Sunday May 20, 2012 ____
Enter the Verification Code