Thank you for signing up for a class. All you need to do now is print out a copy of the application (below) for each person that will be attending the class. Please fill it out and fax it to us at 206-339-8823.
Here are directions to the class (choose the location that your class is being held at):
Feel free to e-mail us at info@loghomebuilders.org if you have any comments or questions. Our voice number is 360-794-4469.
Application for Membership (print this out, sign it and fax it to us)
WHEN COMPLETED PLEASE FAX TO 206-339-8823 AS SOON AS POSSIBLE. THANK YOU.
My name is:___________________________________________________________
I am applying for membership in the Log Home Builders Association of North America -- and to attend the seminar that will be held on the date of _________________________.
Address: _________________________
_________________________________
_________________________________
Telephone: ______________________________
Mobile phone:____________________________
e-mail: __________________________________
How did you hear about us? (Please be as specific as possible) _______________________________________________________________
What made you decide to take our class? (Please be as specific as possible)
________________________________________________________________
Is there anything specific you need addressed in this class? If so, please explain.
________________________________________________________________
Was there anything you liked about our web site?
________________________________________________________________
Was there anything you didn't like about our web site?
________________________________________________________________
The following information is requested in case of injury. This information is strictly confidential and will not be disclosed to anyone outside of the staff of the Log Home Builders Association, unless it is required by a medical caregiver (such as a hospital, doctor, ambulance worker, etc) during the class.
Age: ___________
Occupation: _______________________________________
Where do you work? ________________________________________
Name and contact information for your next of kin: ________________________________________________
List anyone who will be taking this class with you.
________________________________________________
(Please note that all students must have their own membership and submit their
own membership application. This is just to help us organize membership cards.)
If you signed up with a credit card, what is the name on the card? ________________________________________________
Contact information for your family doctor, if any: _________________________________________________________________
Do you have any prior injuries? If yes, please explain: _____________________________________________________________
Do you have any allergies? If yes, please explain: ________________________________
Blood type, if known: _____________________________________________
Social Security number (optional, if it is needed by a hospital) _____________________
RELEASE OF ALL CLAIMS
Please read this RELEASE OF ALL CLAIMS, sign it, and indicate the date of your signature.
My name is (please print): __________________________________________________. I am 18 years of age, or older. In consideration of the acceptance of this application, I hereby release DeWelle Ferguson: Ellsworth (and his heirs, successors, assigns, and agents), and the Log House Builders Association of North America, their instructors, agents, employees, contractors, staff and anybody else who is connected with this seminar and/or the site where the seminar is held, from any and all liability for any injuries or damage whatsoever arising from my participation in or presence at this school, seminar, or place, including any injury or damage whatsoever arising from the knowledge that I gain from my attendance at this seminar. I further agree to Hold Harmless DeWelle Ferguson: Ellsworth from any claims that are made against him as a result of my involvement with this seminar.
I agree that:
1. I will refrain from recording any portion of the seminar via audio, video, mechanical or any other means.
2. I will refrain from taking photographs of any kind, including photographs of the class location, the instructor(s), other students, tools, educational props and devices, or of anything else in any way connected with the class or located in or on the property upon which the seminar is located.
3. I understand that laptop/handheld computers, any type of audio or video recording device, video cameras, still photography equipment, recreational drugs, and alcohol are strictly prohibited from the class and the class location.
I understand that if I violate the rules outlined above I shall be asked to leave the class immediately and shall waive any right to a refund of any kind. I also understand that if I violate any of the rules outlined above I shall have my membership and any benefits associated with it revoked. I also agree that the membership card issued to me remains property of The Log Home Builders Association of North America and I shall return it immediately if I violate any of the above rules.
I further agree that if any portion of this agreement is found to be unenforceable, then the rest of the agreement shall not be effected and shall remain enforceable. I further agree that the tuition is non-refundable if I fail to attend any portion of the seminar.
Signature: _______________________________________
Date: __________________