ANNUAL RENEWAL
 Please make a copy of this form and send in with $65.00 to Grubstakers PO Box 277, Central City, CO. 80427
FIRST NAME _________________________
LAST NAME _________________________
MEMBERSHIP# ________________________

|  | CONTRACTED MEMBERSHIP
 Allows you to pay by the year. You pay $65.00 in advance for the coming year.
When you have paid in a total of $650.00, you become a “Lifetime member".
You only have to remain current in your payments toward your final payoff to enjoy all the benefits of belonging to the PIC-N--PAN PROSPECTOR ASSOCIATION.
PIC-N-PAN
PROSPECTORS ASSOCIATION
MEMBERSHIP APPLICATION
Place order
Click on Application below to print
the link brings up a new window with the application. Just close the window to return here.
Application

|  | LIFETIME MEMBERSHIP
 Pay entire membership fee of $650.00 (this gives you a lifetime status and no further membership payments are required for the rest of your life.
PIC-N-PAN
PROSPECTORS ASSOCIATION
MEMBERSHIP APPLICATION
Lifetime Membership $650.00
Date:___/___/____
Name_____________________
Name & Age of Children:
__________________________
__________________________
Address:__________________
City:______State:__ZipCode_______
DISCLAIMER
RELEASE IN FULL OF ANY AND ALL CLAIMS
For and in consideration of being a member of the PIC-N-PAN PROSPECTOR ASSOCIATION, (PPPA), I/We do hereby aquit and forever discharge the PPPA, it’s members, directors, officers and any other persons, firms, entities or corporations, of any and all actions, claims, demands, costs, loss of service growing out of any and all known and unknown personal injuries and property damage resulting of from the result of any accidents that could occur on any of the club owned or leased properties or at any club sponsored activity on the property of others and not club owned.
I/we, the undersigned, do hereby state that I/we have not been influenced to any extent whatsoever in making this release by any representations or statements regarding said injuries, or liability, or any other matters made by the club, it’s members, directors, officers, hereby released or by any person(s) representing or acting for them.
This release contains the entire agreement between the parties hereto, and the terms of the release are binding and contractual. I/we further state that I/we have carefully read and understand the foregoing release and know the contents thereof and I/we sign the same as my/our free act.
Printed Name
_________________________
Signature & Date
_________________________
Printed Name
_________________________
Signature & Date
__________________________
Copy and print application
Mail completed Application and signed Disclaimer to:
GRUBSTAKER.COM
PIC-N-PAN PROSPECTOR ASSOCIATION
PO BOX 277
Central City, CO 80427
Place order

|