Over The Hill Gang, International
Membership Application
Print this page and complete the application then fax (719-389-0024) or mail to OTHG:
Over The Hill Gang, International
2121North Weber Street
Colorado Springs, CO 80907

Name:
Date of birth:
Work Phone:
Occupation (now or before retirement):

Spouse's Name (if joining):
Date of birth:
Work Phone:
Work Fax #:
Occupation (now or before retirement):

Mailing Address:
City:
State:
Zip:
Home Phone:
Fax Number:
E-mail:

How did you hear about Over The Hill Gang, International?

Choose from either Individual or Couple Membership:

Individual Membership (circle ONE of the following):
Annual $60
3 Year $135
Life $515 (Age 50-62) $345 (Age 63+)

Couple Membership (circle ONE of the following):
Annual $100
3 Year $210
Life $855 (Age 50-62) $575 (Age 63+)

*If your address is outside the United States, please add the following amount to your dues: Canada residents $20.00(US currency) per year ($100 for Life members); all others $25.00 per year ($125 for Life members).

Payment Information

Payment can be made by check, MasterCard, or VISA

Check enclosed - check #:
Credit card number:
Expiration date:

IMPORTANT! To complete your application for membership...
Please Read and Sign This Release and Waiver of Liability

The Over The Hill Gang, International is a year-round social and sports organization providing a variety of activities for its members. Most of the activities are, to varying degrees, hazardous. By making this application for membership, I voluntarily assume the risks involved. By assuming all risks involved, I agree not to hold the Over The Hill Gang, International, its officers, Board members, employees or agents or members liable for any accident. Membership dues are not refundable. After reading this release, I hereby apply for membership in Over The Hill Gang, International.

**Signature of Applicant:
**Date:

**Signature of Spouse:
**Date: