2008 Membership Application
Western Pennsylvania Mushroom Club

The purpose of the Western Pennsylvania Mushroom Club is to promote the enjoyment, study, and exchange of information about wild mushrooms.  Everyone who has an interest in wild mushrooms is welcome to become a WPMC member.  Members are entitled to:

The WPMC newsletter
Nine monthly WPMC meetings
Free participation in WPMC walks
Fee discount for WPMC forays
Fee discount on WPMC-sponsored merchandise

Name:

 _____________________________________

    Phone:

 __________________________

Address:

 _____________________________________

    E-mail:

 __________________________

 

 _____________________________________    

City:

 _____________________________________

County:

 __________________________

State:

_________________________________    Zip:

_______  

Interests:

_____Learning Mushrooms

_____Photography

_____Club Committees

_____Eating Wild Mushrooms

_____Toxicology

_____Cultivating Mushrooms

_____Mushroom Walks

_____Mushroom Art

_____Dyeing With Mushrooms

_____Other _____________________________________

  

How many wild mushrooms do you think you could identify?     ______________

WE NEED YOUR HELP
         WHAT AREA WOULD YOU LIKE TO HELP WITH?
                 PLEASE CHECK THREE POSSIBLE ITEMS OF INTEREST

We can have a lot of Fungi, Fun, and Friends but it takes your participation to make it happen. Please find 3 things you would like to do, and check the appropriate boxes.

   Scout for walk locations and lead walks

   Compile meeting and walk sign-in sheets

   Help organize forays

   Present or assist with a club workshop

   Print club materials, flyers, etc

   Call or e-mail members

   Work on the Newsletter committee

   Give a program at a Club monthly meeting

  Contribute to the newsletter

   Produce or acquire teaching materials

   Help with web page and e-group moderator

   Welcome and orient new members

   Line up speakers for meetings

   Work on the Hospitality committee

   Host guest speakers and mycologists

   Participate in special projects

   Record meetings, discussions, events

   Record mushrooms that are found

  

Sell club items such as t-shirts and cookbooks

   Work on the Door-Prize committee

   Publicize meetings, forays, events

   

Outreach - speak to other clubs, nature centers, and organizations

   Club Historian

   Help with sign-in at walks and meetings

 Other: ______________________________________________________________

Dues enclosed:  $____________    ($20  Family,  $15  Individual,  $10  Full time student)

Return completed signed and dated form with check payable to WPA Mushroom Club to: 
Bonnie Bailey, 120 Mt. Blaine Drive, McMurray, PA 15317

Signing and dating the release is an absolute requirement for membership. If you don't, your membership application will be returned.   

Western Pennsylvania Mushroom Club
2008 Release and Indemnification Agreement

This Release and Indemnification Agreement (the "Agreement") is entered into by and between the Western Pennsylvania Mushroom Club, as it is presently organized and may be later structured ("WPMC") and the undersigned Member (the "Member") on this ____ day of _____________________, 2008.

WHEREAS, WPMC is a non-profit educational organization that has as its principal purpose the sharing of mushroom-related information among its members; and

WHEREAS, all officers, directors, identifiers and members serve WPMC in a voluntary capacity and receive no remuneration for their services; and

WHEREAS, in cases where WPMC charges a fee for its forays, walks, lectures and other events (collectively "WPMC Events"), it is doing so only to cover its direct costs and does not operate in a for-profit capacity; and

WHEREAS, the Member understands that there is inherent and unavoidable risk in outdoor activities relating to hunting and consuming wild mushrooms. These risks include but are not limited to the dangers of hiking in difficult terrain, the possibility of misidentifying a wild mushroom, and the possible allergic or toxic reaction that some individuals may have to otherwise edible mushrooms.

NOW THEREFORE, the Member hereby agrees to the following:

1. The Member assumes all risks associated with WPMC Events. The Member expressly acknowledges that it is the Member's sole responsibility to hike safely and to determine whether a wild mushroom may be consumed.

2.  The Member releases, holds harmless, and indemnifies the WPMC, its officers, directors, identifiers, and representatives from any and all liability relating to any injury or illness incurred by the Member or the Member's family members as a result of participation in a WPMC Event.

This Agreement shall be governed by the laws of the Commonwealth of Pennsylvania.  If any portion of the Agreement is declared for any reason to be invalid or unenforceable, such invalidity shall not affect any other provision of the Agreement.  This Agreement shall apply to all WPMC events for the calendar years 2008.

MEMBERS:

Signature
(if Participant is under age 21, signature of Parent or guardian)

Please print name

1 ______________________________________

1 ______________________________________

2 ______________________________________

2 ______________________________________

3 ______________________________________

3 ______________________________________

4 ______________________________________

4 ______________________________________

2/07

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Last updated January 2, 2008