Please fill out application completely. Incomplete application will not be processed. Please enable JavaScript in your browser to complete this form.Name *FirstLastPayment Method (Dues are $35 per member beginning July 1st and ending June 30th) Note: A portion of membership dues are being put into a savings account for the development of permanant courts in Jefferson City. *Check PayPal/Credit CardVenmo (JCPBC)Make checks payable to Jefferson City Pickleball Club. Mail check to: Jefferson City Pickleball Club, PO Box 105241, Jefferson City, MO 65110Incentive Club Items (Check items that you want to receive)3D Pickleball KeychainVinyl JCPBC DecalMember Information *All information is currentUpdate the following informationMailing AddressCityStateZipPhone NumberEmailEmergency Contact NameEmergency Contact Phone NumberGenderMaleFemaleWould you like to be included in Jefferson City Pickleball Member Directory? I understand that my name, telephone number, email and a photo will be published in JCPBC Member Directory and will be emailed to members that chose to be in the directory.YesNoClub Waiver *I have read and agree to the Club Waiver Club Liability Release Form: I hereby release the Jefferson City Pickleball Club (JCPC) and their officers from any and all actions, cause of action, claims and demands, for, upon, or by reason of any illness, damage, loss, personal injury or death which may be a result from or in connection with any participation of any nature in any of or in connection with my participation of any nature in any of the Jefferson City Pickleball Club (JCPC) activities. I understand that this release is binding upon me, my assigns, my personal representatives and heirs. Photo Release Form: I grant permission to Jefferson City Pickleball Club (JCPC), to use photographs of me for use on its website, advertisements, educational purposes or programs, or any other JCPC promotional literature. I waive all rights to inspect or approve the photographs which may be used now or at any time in the future, on the JCPC website, advertisements, publications, or any other printed material whether known to me or not. I further waive any right to compensation of any kind, or royalties in connection with the use of the photographs. I agree to release and hold harmless Jefferson City Pickleball Club and its representatives from any claims, liabilities or damages arising from the use of the photographs, including re-use, distortion, alteration or use in composite form whether intentional or not, that may occur in production of the finished product. I am at least 18 years of age and competent to contract in my own name. If I am not 18 years old or not competent to contract in my own name, a parent or guardian has signed this authorization on my behalf. If this photo release is given on behalf of a child under 18 I understand that the child’s name will not be published. I have read and understand the contents of this release, and by my checking the waiver checkbox, I accept and agree to be bound by its terms.Additional comments or SuggestionsSubmit Renewal