Name

Address

Home phone number

Mobile phone number

ICE number (relative or friend to contact in case of emergency)

Email address

Birthday (DD/MM)

Nom de chapeau: (a frivolous ‘Red Hat’ name for you, eg Lady Godiva, Princess Potty etc. This could be connected to an interest or a place name that means something to you)

Do you give your permission for chapter photographs in which you appear to be displayed on our website?

Yes
No

Please read and tick the check box below

User Agreement

In submitting this form, I confirm that I understand and agree that my participation in any events, programmes and trips organised, operated and conducted by the 'Milton Keynes Scarlet Sparkles' Chapter of the Red Hat Society is entirely at my own risk.

I agree not to sue, and further I agree to indemnify and save harmless the members of the above named chapter from any and all claims, debts, actions and liability which may arise directly or indirectly from participating in any or all events, programmes, trips and activities for any loss, injury, death or damanges, however caused or arising.

I understand the risks and accept the terms and conditions which apply to my being a member of the above chapter. I understand that the events in which I take part, wherever they may take place, are entirely at my own risk.