This application form is for lapsed or returning members that do not have a 2024 membership.

For other membership options, please visit the Membership Resources page for more information.

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Applicant Information

Name *

First

Last

Email *

Birth Date *

(IWLA National requires this information for membership.)

Sponsor Name *

First

Last

New members must be sponsored by a current, active member in good standing.

Contact Information

Phone *

Address

Address Line 1

Address Line 2

City

--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Emergency Contact Information

Name *

First

Last

Phone *

RelationshipSpouseFamilyFriendOther

Membership Type & Information

Membership Type

• Family Membership
• Individual Membership
• Senior Membership
• Student Membership

Family Membership Info

 

The Family Membership is intended solely for the spouse of the primary member to participate as a independent member, rather than a guest.

 

Other adult relatives living in the same household are expected to purchase their own memberships if they would like the full benefits of membership.

Secondary Member Name *

First

Last

Secondary Member Birth Date

Senior Certification *

• I certify that I am currently 65 years old, or older

Senior Birthdate

Student Certification *

• I certify that I am currently under 25 and enrolled in undergraduate classes full time

School Name

Dues and Fees

Individual Membership dues

Price: $175.00

New Individual Application fee

Price: $87.00

Family Membership dues

Price: $230.00

New Family Application fee

Price: $115.00

Student Membership dues

Price: $70.00

New Student Application fee

Price: $35.00

Senior Membership dues

Price: $140.00

New Senior Application fee

Price: $70.00

Total

$0.00

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Member Release and Waiver

CHRISTIANSBURG MONTGOMERY CO. CHAPTER OF THE IZAAK WALTON LEAGUE OF AMERICA RELEASE FROM LIABILITY/ MEDIA RELEASE

 

I understand the nature of the Christiansburg Montgomery Co Chapter of the Izaak Walton League of Amerca's Member's experience and capabilities and believe the Member to be qualified to participate in such Activities. I further acknowledge that my activities will be conducted in facilities open to the public. I, the Releasor, being of lawful age hereby releases the Christiansburg Montgomery Co Chapter of the Izaak Walton League of America its officers, agents, board members, volunteers, their heirs, administrators and executors, (herein collectively referred to as "Cburg Mont Co. IWLA").

 

I, the Releasor, in consideration of being permitted to participate in various shooting disciplines and activities at the Cburg Mont Co. IWLA facility, either as a registered participant in Cburg Mont Co. IWLA activities or guest, do for myself, my spouse, legal representatives, heirs, assigns and subrogors, hereby release, waive, and forever discharge Cburg Mont Co. IWLA from any and all liability for any and all losses and damages of any type or kinds, and from any and all claims, suits, demands, actions or rights of actions, of whatever kind, either in law or equity, arising from or by reason of death, personal injury known or unknown, or property damage resulting from any incident which may occur during the Releasor's presence at the Cburg Mont Co. IWLA facility/property, and/or participation in any activity, whether caused in whole or in part by the Cburg Mont Co. IWLA or any other person or thing at the host while Releasor is present. Releasor agrees to fully indemnify, defend and hold Cburg Mont Co. IWLA harmless for all Releasor's actions or omissions while at the Cburg Mont Co. IWLA facility/property. There is no limit to this indemnity.

 

I, the Releasor, assume full responsibility for the risk of bodily injury, death or property damage due to the negligence of Cburg Mont Co. IWLA or any third party or thing while at the Cburg Mont Co. IWLA facility/ property, and while competing, officiating, working, spectating, or for any purpose at the Cburg Mont Co. IWLA facility/property.

 

I, the Releasor, fully and completely release Cburg Mont Co. IWLA and any of its related parties of and from all liability to the Releasor and to anyone or any entity claiming by, through, or under the Releasor, by subrogation or otherwise, it being the Releasor's intent to fully waive and release all subrogation rights.

 

I, the Releasor, agree that this release constitutes the entire agreement between the Releasor and Cburg Mont Co. IWLA and its affiliated parties, and that the terms of this release are contractual and not a mere recital, and the same shall continue in full force and be applicable to any and all activities the Releasor attends while at the Cburg Mont Co. IWLA facility/property.

 

I, the Releasor, agree that this Release from Liability Agreement, is intended to be as broad and inclusive as permitted by law, and that if any portion hereof is held invalid, the balance hereof will continue in full force and effect.

 

BY SIGNING ABOVE, I, THE RELEASOR, HAVE CAREFULLY READ THIS RELEASE AND UNDERSTAND ALL OF ITS TERMS. I, THE RELEASOR, EXECUTE THE SAME VOLUNTARILY AND WITH FULL KNOWLEDGE OF ITS CONTENT AND SIGNIFICANCE.

 

The member/guest must follow posted safety guidelines for shooters at the facility, and recognized safety guidelines as identified in any event or tournament hosted by Cburg Mont Co. IWLA and/or its constituent leadership.

Primary Member Signature *

Clear Signature

To sign with a mouse, click and hold down the left mouse button while signing, as if you were using a paint program. For touchscreens, tablets, and phones, the form can be signed using your finger as a pen.

Secondary Member Signature *

Clear Signature

To sign with a mouse, click and hold down the left mouse button while signing, as if you were using a paint program. For touchscreens, tablets, and phones, the form can be signed using your finger as a pen.

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Information Doublecheck *

• Everything looks good!

Reminder: Your membership application is not complete until reviewed and accepted by the chapter membership secretary, and you have met new member requirements.

Next Steps

You will receive an email confirming your application has been received. We will complete the process when you appear at either the January or February chapter meetings. (Jan 19 or Feb 16 2023)

 

Bring the following items with you to the meeting:

 

• Application: The email showing receipt, or a printout of the application.
• Payment: Cash, check, or money-order are the only forms of payment that can be easily accepted in-person. Credit card payments may not be working in time for the Jan. chapter meeting.
• Sponsor: Your sponsor must appear with you at the Chapter meeting, as part of the induction process.

Final Acknowledgement *

• Attend Chapter intake meeting with my sponsor - Got it.

Total Amount Due ($USD)

$0.00

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