Lake Travis Powerboat Association

Dedicated to Powerboat Safety

2017 MEMBERSHIP APPLICATION

Members must be at least 21 years of age.

Member Contact Information

Name
Address
City, State & Zip
Cell Ph
W ork Ph
E-Mail

Boat Information
Make Model Length State or Coast Guard Boat Name
Number

Membership
All dues are for a calendar year. Memberships are subject to the provisions of t he Articles of Incorporation and t he Bylaws of t he
Associat ion.

Annual Membership $150.00:

2 Membership Shirts
2 Boat Decals
2 Membership Cards
$50 Poker Run Hands
Discounted Fuel at participating Marinas

Shirt Sizes
Mens: Small Medium Large XL XXL XXXL
Ladies: Small Medium Large XL XXL XXXL
Mail To:
Membership Committee
Lake Trav is Powerboat Association
c/o Cory Fleitz
407 Lido
Lakeway, TX 78734

Ship Membership Package to me (add $10 for shipping & handling to your membership dues)
Make checks payable to: Lake Travis Powerboat Association
 Lake Travis Powerboat Association
Dedicated to Powerboat Safety

2017 MEMBERSHIP APPLICATION

Members must be at least 21 years of age.
In Consideration of THE LAKE TRAVIS POWERBOAT ASSOCIATION hereafter referred to as LTPA Accepting this application and
allowing myself, crew, and guests to participate in any ev ent the undersigned for myself, my heirs, executors, administrators
and assigns hereby release and agree to indemnify and hold harmless LTPA, their affiliates sponsors, organizers, and officia ls
and their respectiv e agents from any claim, demands, damages, actions or cause of action arising out of or in consequence
of attendance or participation in any related ev ent. Not withstanding that any such loss or injury or damage may hav e arisen
by the reason of including but not limited to the negligence of LTPA, their sponsors, organizers, or officials. The undersigned
further agrees to hold LTPA, their sponsors, organizers, or officials harmless and does hereby indemnify them from any and all
liability for personal injury or property damage to third parties which may occur in any manner arising out of my attendance at or participation in events
of the LT PA. T he undersigned further acknowledges that the LTPA events are not a race and that speed in no way determines the outcome of the event
and hereby agrees to abide by any and all rules, terms, and condition of the LT PA event as set forth either verbally or in writing before or during the
event. T he undersigned further agrees to abide by all state and federal laws and that the boat used to participate in the event is in safe operating
condition and complies with and meets all of the requirements set forth by the United State Coast Guard.

NOT ICE OF FILMING AND PHOT OGRAPHY: When you participate in a Lake T ravis Powerboat Association (LT PA) event, photography and
video recording may occur. By participating, you consent to photography, video recording, and its/their release, publication, exhibition, or
reproduction to be used for news, web casts, promotional purposes, telecasts, advertising, inclusion on websites, social media, or any other purpose
by the LT PA and its affiliates and representatives. You release the LT PA, its officers and employees, and each and all persons involved from any
liability connected with the taking, recording, digitizing, or publication and use of photographs, computer images, video and/or or sound
recordings. By participating in an LT PA event, you waive all rights you may have to any claims for payment or royalties in connection with any use,
exhibition, streaming, web casting, televising, or other publication of these materials, regardless of the purpose or sponsoring of such use, exhibiting,
broadcasting, web casting, or other publication irrespective of whether a fee for admission or sponsorship is charged. You also waive any right to
inspect or approve any photo, video, or audio recording taken by the LT PA or the person or entity designated to do so by the LT PA.

(Signature) (Printed Name) (Date)

By signing up for the LTPA I have read, understand, and agree to the terms of the liability waiver and
will follow all rules and regulations.