Membership Application

ITASCA COUNTY PICKLEBALL ASSOCIATION

MEMBERSHIP YEAR IS FROM JANUARY 1ST - DECEMBER 31ST.

1 YEAR SINGLE MEMBERSHIP	$30	2 YEAR SINGLE MEMBERSHIP	$55
1 YEAR COUPLE MEMBERSHIP	$50	2 YEAR COUPLE MEMBERSHIP	$90
1 YEAR FAMILY MEMBERSHIP (same household)	$60	2 YEAR FAMILY MEMBERSHIP (same household)	$110

First Name*

Last Name*

Email*

Phone Number*

Password*

Confirm password*

Address*

City*

State*

Zip*

RELEASE & WAIVER OF LIABILITY

I/we agree there is a risk of illness, injury or death associated with my use of pickleball facilities and that I/we am/are voluntarily participating in the activities of the ICPA. I/we thereby release, waive, and forever discharge ICPA and its officers, directors and members from any and all claims, demands, damages, actions and lawsuits from any illness, injury or death I/we might incur.

Member Signature*		Date:
Spouse/Partner Signature		Date:
Additional Family Member Signatures		Date:

RELEASE OF MEMBER INFORMATION

I/we agree to have my/ our contact information shared with other ICPA members for ICPA activities only.

Member Signature*		Date:
Spouse/Partner Signature		Date:
Additional Family Member Signatures		Date:

Verification Code

ITASCA COUNTY PICKLEBALL ASSOCIATION MEMBERSHIP INCLUDES:

Balls / Nets / Loaner Paddles	Voting Privileges/ JUNE Annual Membership Meeting
Social Events /Fun!	Storage Facility Code (For Equipment Use At Our Venue Sites )
Access to Tudor Pickleball Training Machine	Email Updates (grandrapidsicpa@gmail.com)
Organized Play At Scheduled Times	Association News via Our Website
Friendly Competitive Club Events	Local Tournament Discounts