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
1515 North Tejon 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. After reading this release, I hereby apply for membership in Over The Hill Gang, International.

**Signature of Applicant:
**Date:

**Signature of Spouse:
**Date: