Online indemnity form​

Primary Member

Primary Member Membership Level *
Profile Pic
Maximum file size: 2 MB
First Name *
Identity Number *
Birth Date
Password *
Last Name *
Email *
Confirm Password *
Street Address *
Address Line 2
City *
ZIP / Postal Code *
State / Province / Region *
Cell *
Home Tel
Work Tel

Emergency Contact

Emergency Contact First Name *
Emergency Contact Last Name *
Relationship with Emergency Contact *
Emergency Contact Cell *
Emergency Contact Home Tel
Emergency Contact Work Tel

Health History

Physical disabilities / allergies / illnessess if any

Dependent Members

Total Family Member Cost


Membership Terms and Conditions *
Click hereto read the Membership Terms and Conditions
Assumption of Risk and Waiver of Liability *
Click here to read the Assumption of Risk and Waiver of Liability