*First Name: *Last Name:         

Date:

*Address:             Apt#:

*City:            *State:

*Zip Code:

*Home Phone #   Interview By: Online

Mobile#

*E-Mail Address:

*Birth Date:

*T-Shirt Size:

Type of Vehicle: Year:  Lic. Plate #:

Type of Work:             Phone#:

I *from this date forward as God is my witness do pledge, My Commitment, My Honor, My Team, and My Brotherhood to The South Bay Raiders Booster Club.

I * as a member of the South Bay Raiders Booster Club understand that I am responsible for my conduct at all or any South Bay Raiders Booster Club sponsored events, and I do hereby release, absolve, indemnify and hold harmless South Bay Raiders Booster Club and any organizers, sponsors, board members, land owners and participants and any other person (s) or entity duly acting on the behalf of South Bay Raiders Booster Club, from any claims arising out of injury (s), of any nature, to any member (s) and their family while participating in any South Bay Raiders Booster Club activities.

*I agree to follow all the rules & regulations and pay and renew my membership every year.