Old Dominion Model A Ford club

Old Dominion Model A Ford clubOld Dominion Model A Ford clubOld Dominion Model A Ford club
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Old Dominion Model A Ford club

Old Dominion Model A Ford clubOld Dominion Model A Ford clubOld Dominion Model A Ford club
Home
Calendar of Events
Photo Gallery
Technical
Memorial
Featured Cars
Membership Application
FOR SALE
Frequent Questions
Tours and Trips
More
  • Home
  • Calendar of Events
  • Photo Gallery
  • Technical
  • Memorial
  • Featured Cars
  • Membership Application
  • FOR SALE
  • Frequent Questions
  • Tours and Trips
  • Home
  • Calendar of Events
  • Photo Gallery
  • Technical
  • Memorial
  • Featured Cars
  • Membership Application
  • FOR SALE
  • Frequent Questions
  • Tours and Trips

Membership Application

 

MODEL A FORD CLUB OF AMERICA

OLD DOMINION CHAPTER

APPLICATION FOR MEMBERSHIP


Application Date                                                  


(Please print)

Name                                                                                                              .Spouse’s Name                                                                                                                                                     


Birthday (Mo/Day)                                                                   Birthday (Mo/Day)                                                                              


Phone #                                                                     Cell #                                                                    


Address                                                                                                             EMAIL                                                                                                             


City                                                                                                                                      State                                     ZIP Code                                          


Occupation                                                                    

If owned, please list Model A owned by Applicant/Member: (Year and Body Style)

                                                                                                                                                                   


Club Fees: New Member   $30.00                Member Renewal   $20.00

   

Total Enclosed $                                                                    

Make checks payable to Old Dominion Model A Club and remit with completed application and Release and Waiver form to: 

Henry Nelson, 3600 New Market Rd., Richmond Va 23231


Is your Model A insured for liability Yes                                    No                                                                    


If “No” Please give reason                                                                    


Additional Club Affiliation

Membership is required in one of the following National Clubs:

MARC - Membership #                                           

 MAFCA - Membership#                                           


Recommended By Club Member/Mentor:                                                                        



                                                                                                                                                                                 3/2021 NT        NMP           




Old Dominion Model A Ford Club (ODMAFC)

Release and Waiver of Liability.

Assumption of Risk and Indemnity Agreement

In consideration of being a member of ODMAFC and participating in any way in any Old Dominion Model A Ford Club events or activities sponsored or otherwise.

I, for myself, my personal representative, heirs and next of kin:

1. Hereby Release, Waive, and Discharge ODMAFC, it Officers, Directors, Members and their heirs, all for the purpose referred to as RELEASEES, from al liability, for any and all loss of damages therefore on account of injury to the person or property or resulting in the death of the undersigned arising out of or relating to as a result of activities associate with Club events, sponsored or otherwise, auto repair assistance, technical advice, and any other area relating to the Model A Hobby.

2. Hereby assume full responsibility and agree to indemnify and save and hold harmless the RELEASEES and each of them from any loss, liability, damage, or cost they may incur due to claims brought against the RELEASEES.

3. Hereby agree that this Release and Waiver of Liability, Assumption of Risk Indemnity Agreement extends to all acts of negligence by the RELEASEES and is intended to be and inclusive as is permitted buy the laws of the Province or State in which activities were held.

4. I grant to ODMAFC the right to take photographs of me and my property in connection the above identified subject in a lawful manor.

 I have read this Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement, fully understand its terms, and have signed it freely and voluntarily without any indictment, assurance or guarantee being made, and intend my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.


  Signature                                                                                                         Date                                                             


 

Files coming soon.

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