Havasu Gold Seekers, Inc

Individual or Family Membership Application & Hold Harmless Agreement

This is an example of the Membership form, please click on link to the left to print off application.

Last Name___________________First Name________________ Spouse or Partner_____________________ 


Name (s) of Minor Children_______________ Age____   _______________Age___  _____________________

Age____  __________________ Age____ _______________ Age____ ________________________________


City___________________________ State ___________________________ Zip________________________

Day Phone ________________________________Evening Phone____________________________________

Mail Address (same )________________________________________________________________________

City___________________  State ____________Zip________ E mail address___________________________

Yearly Individual or Family membership dues are $ 40.00 for Jan 1st thru Dec 31

Initiation Fee for Individual or Family membership is $ 100.00. Total cost for new membership is $140.00

$ 40.00 for each subsequent year which is Jan 1 Thru Dec 31

  Prospecting Vehicle Make:_______________Year______Color_________ Lic._________________State_____

  Prospecting Vehicle Make: _______________Year_____ Color_________Lic._________________ State_____

  Metal Detector Make:___________________________Model _______________________________________

  Other Equipment:____________________________Member of any other Prospecting Clubs:_______________


I / We, the undersigned,( herein after referred to as participant ) assume all risks and or hazards association with participant’s involvement in the Havasu Gold Seekers, Inc. Prospecting Association. Participant agrees to indemnify and hold harmless all Club Officers, Sponsors and/or other, fourth, fifth, etc. parties involved in club activities.

Participant realizes that metal detecting, gold prospecting and associated activities can be dangerous. The terrain can be hazardous and may be wild and domestic animals, insects, snakes, etc. present. Some locations may have open shafts, pits and tunnels. Some areas may be suitable only for four –wheel—drive vehicles.

Participant assumes full responsibility for any injury, loss or liability which may result or be alleged to have resulted from involvement in these activities. This includes, but is not limited to, loss of life, limb and sight. Loss and liability is also accepted for, but limited to metal detector, mining equipment, pets and vehicle. This agreement includes the trip to and from the actual location of Havasu Gold Seekers, Inc. properties and claims.

In case of injury or sudden illness, Participant hereby accepts needed first aid and gives authorization to any hospital, doctor or emergency personnel to render immediate emergency aid as may be required at the time for Participant’s health and safety.

It is understood by Participant that the expense of professional services is accept by Participant. This document applies to any and all activities while on Havasu Gold Seekers, Inc. properties or claims in which Participant is

involved. It applies not only to the date of signature but to any and all future dates. This will be in effect until and unless revocation is received.        

Bring this application to the next Club meeting or mail application and your check to;

Havasu Gold Seekers Inc., P.O. Box 3281 Lake Havasu City, AZ. 86405-3281

 Signature of participant:__________________________________________________________Date___________

 Signature of Participant:_________________________________________________________Date ___________

 Name (s) of Minor Children:_____________________________________________________________________


  Signature of Parent (s) or Legal Guardian (s)