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Please print and return this application along with 2000N per person to the leader of the next event you attend.

Alternatively: Click on "File", "Send", "Page by E-mail" to membership coordinator.

Name: First Last

Home address: Check here if you do not wish your info shared with other members: [ ]

(only your first name, cell phone number, and e-mail address are ever shared)

Business phone:

Home phone:

Cell phone:

e-mail address (PRINT):

For each of the following, check all that apply:

Activity Interests	Resources/equipment you can muster/share with others	Special expertise you have
1 Outdoor such as hiking, camping, boating, etc., other: Cultural such as museums, festivals, arts & crafts, etc., other:	2 Gear: Camping Spelunking (caving) Rock climbing Boating Snorkeling SCUBA Road biking Off-road biking Other: Transportation: Specialized/4WD vehicle Van/Bus – capacity ____ Driver available	3 Outdoor: Camping Spelunking (caving) Rock climbing Boating Snorkeling SCUBA Road biking Off-road biking Other: Cultural: African/Nigerian history Arts/Crafts Customs Local language(s)
4 Certificates / entry permits / discounts you hold and can share:

Received of: ____________________________________________________________ Date: ________________________________

Amount: ______________________________________________________________________________________________________

Nigerian Field Society – Abuja Branch Membership Dues for: ___________________________________________________________

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Liability Waiver

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I, the undersigned, agree to abide by all the rules and regulations of the Nigerian Field Society, the Nigerian Field Society of Abuja, and of the laws of the country of Nigeria and its various departments, and by any rules, regulations, or laws of any other country or place I might visit as a member of the Nigerian Field Society of Abuja. I also agree to inform myself fully regarding the nature of any activity I might undertake with the Nigerian Field Society of Abuja, that I am wholly and fully responsible for inspecting any and all gear or equipment which I might use during any activity of the Field Society of Abuja, and not to act in such a way while participating in any such activity as to increase the danger to myself, to any dependents I may bring with me to such activity including ones for whom I am not legal guardian, to other participants in such activity, or to any other person or creature involved in such activity.

Furthermore, I understand that the activities I may undertake may entail certain risks of harm, injury, disease, dismemberment, or even death from such hazards as, but not limited to: vehicular accidents, highwaymen, robbery, kidnapping, police/military/paramilitary harassment; Dengue fever, malaria, various food and water borne diseases; floods and other associated hazards during the rainy season as well as dust and other associated hazards during the dry season. I understand the full and complete nature of these risks, take them on freely and willingly, and I, my executor, my successor(s), and my assign(s) will indemnify and hold harmless the Nigerian Field Society, the Nigerian Field Society of Abuja, any and all officers of the said Societies, any and all other member(s) of the said Societies, and any provider of services to the said Societies.

Signature: Date:

Print your name:

In case of emergency: Please supply at least one phone number - of a person not likely to be on a trip with you!

Name: First Last

Home address:

Business phone:

Home phone:

Cell phone:

e-mail address (PRINT):