Membership Forms – Printable and Online

Complete the easy steps outlined below to activate your Sequim Picklers Membership.

Online Submission:

Step (1). Complete the online Membership Form below and hit “submit.”
Step (2). Once your form has been submitted, pay your dues using the PayPal link below the online form. *You may also mail in your payment by check to Sequim Picklers, PO Box 3441, Sequim WA 98382.
Step (3). You will receive a Welcome Letter to the email provided from our Membership Chair to confirm your Active Membership once Step 1 and Step 2 have been completed. (If you mail a check, please allow 1-2 weeks to receive confirmation.)

The Old-Fashioned Way (Print your form & Mail in Your Payment):

Step (1). Click HERE >>2023 Sequim Picklers Membership & Liability Form-Printable Version to bring up a printable version of the Membership form. Print the form.
Step (2). Fill out the form completely and send it with a check for your Membership Dues to Sequim Picklers, PO Box 3441, Sequim WA 98382.
Step (3). Once your form and payment have been received, you will receive a Welcome Letter via email from our Membership Chair to confirm your Active Membership within 2-4 weeks.

ONLINE MEMBERSHIP FORM

Membership & Liability Form

My Name

First

Last

Preferred First Name (if different than above) for one FREE Member Name Tag

Email (by providing your email address, you agree to be added to our email contact list. You may unsubscribe at any time.) *

Confirm Email

If this is a Household membership, enter name of Household Member/2nd Adult living at the same address

First

Last

Preferred First Name of Household Member/2nd Adult (if different than above) for one FREE Member Name Tag

If this is a Household membership and you are using separate email accounts, enter email address of Household Member/2nd Adult living at the same address (*By providing an email address, you agree to be added to our email contact list. You may unsubscribe at any time.)

Confirm Email for Household Member/2nd Adult if using separate email accounts

Children (Under Age 18) Names (For Household Membership)

Address (Best Contact Address) *

City *

State

ZIP Code

Enter Your Contact Phone

If this is a Household membership, enter Contact Phone of Household Member/2nd Adult

I agree to allow my name/adult household member's name, email address and best contact phone to the Contact List published on the Sequim Picklers site (password protected for Active Members Only). (Select YES or NO from the dropdown menu.)

Emergency Contact

First

Last

Emergency Contact Phone

Age *

I am 18 Years or Older

I am Under 18 Years Old

Liability Waiver: In consideration of being permitted to use the facilities, on behalf of myself, my family, my heirs, and my assigns, I hereby release the Sequim Picklers, their employees and agents, from liability for injury, death, or loss suffered by me, while using the facilities or in any way associated with participating in any and all Sequim Picklers activities now or in the future, resulting from ordinary negligence of Sequim Picklers, their agents or employees. By the execution of this agreement, I assume full responsibility for any and all injuries or damages which may occur to me (including loss or theft of personal property) as a result of negligence on the part of Sequim Picklers, or their agents or employees. I affirm there are inherent risks in all health, fitness and sports activities, that I am aware of and appreciate these risks, and that I assume all responsibility for personal injury, death, or loss resulting from these injuries. The undersigned hereby agrees to defend, indemnify, and hold harmless Sequim Picklers, their officers, employees, and agents from and against any and all loss, liability charges and expenses (including attorney’s fees), and costs which may arise by reason of my voluntary participation in any activities. Sequim Picklers shall not be liable for any damages arising from personal injuries sustained by me. The undersigned assumes full responsibility for any injuries or damages that may occur to myself or my property during my voluntary participation and do hereby fully and forever release and discharge Sequim Picklers and their agents, from any action or cause of action present or future, whether the same be known or unknown, anticipated or unanticipated, resulting or arising out of my voluntary participation. I certify that I am the participant, or I am the parent or legal guardian of the participant named above, that I have read and understand the foregoing release, and that I join the release without reservation, granting full consent and authorization for the above-named person to participate in the activity. Enter Your Full Name Below to Agree to the Liability Waiver.

If you selected Household Membership, enter FULL NAME of Household Member/2nd Adult to acknowledge the Liability Waiver:

Please Check One *

Participant/s

Parent

Guardian

Select your Membership Dues *

BASIC / Individual -$50 (Annual Renewal)

BASIC / Household - $75 (Annual Renewal)

BRONZE-$500 (Lifetime Membership/No Annual Renewal/Tournament Discount)

SILVER-$1,000 (Lifetime Membership/No Annual Renewal/Tournament Discount)

GOLD-$2,500 (Lifetime Membership/No Annual Renewal/Tournament Discount)

After selecting Membership Dues, choose ONE of the following options for payment:

PayPal (proceed to the PayPal box below after your form is submitted for dues payment)

I will mail a check to Sequim Picklers, PO Box 3441, Sequim WA 98382

I will leave a check made to Sequim Picklers in the box inside the shed at Carrie Blake Park.

Date *

reCAPTCHA

**PLEASE MAKE YOUR DUES PAYMENT AFTER YOU HAVE SUBMITTED YOUR MEMBERSHIP FORM.**