Member Key Tag#Member InformationName* First Last Membership Status* New Member Renewal Date of Birth* MM DD YYYY Sex Male Female Address* Street Address Address Line 2 City ZIP / Postal Code Home Phone #Mobile Phone #Email Address In Case Of EmergencyName of local friend or relativeRelationshipHome Phone #Cell Phone # Declarations: Please Check All Boxes* I understand that I will receive information about the BOAA programs, services and events via mail, email or other electronic means. * I understand that photos taken during activities may be used in print or electronic media for marketing purposes. * I agree to adhere to the BOAA Member Code of Conduct Waiver I understand there is a risk of physical injury associated with the use of the facilities and I, for myself and my heirs and any other claimant under law, hereby fully and forever release, the Bowmanville Older Adult Association and its elected officials, officers, directors, employees and agents from any and all actions, damages, and demands of whatsoever kind or nature at law or in equity which I may have against the Corporation of The Bowmanville Older Adult Association arising from my use of the facilities/equipment or participation in the activities. Volunteer InformationAre you interested in volunteering with the BOAA?* Yes No Method of PaymentCashChequeCreditDebitTo register by method of cash, cheque or debit, please visit the BOAA at 26 Beech Avenue Bowmanville. If you wish to pay by credit card online, you will be redirected after submitting this form to a secure payment page. CommentsThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle AJAX powered Gravity Forms.