Oakbrook Swim & Tennis Club, Inc.

Member consent to posting personal information

on corporate website and waiver of liability

I ______________________ authorize Oakbrook Swim & Tennis Club, Inc. “Oakbrook” to post the following personal information on the corporate website without restrictions:

Name:____________________________________________

Certificate Number:_________________________________

Email Address:_____________________________________

Mailing Address:___________________________________

Phone Numbers:___________________________________

I fully understand that the above information can be viewed by the general public and that the information will remain on the website until I make a written request to Oakbrook to remove the above information.

I hereby release Oakbrook, its employees and Board Members from any and all claims and liability for damages, losses, or expenses of any sort arising from the posting of my personal information on the corporate website.

By signing this consent, waiver and release of liability, I acknowledge that I have read this consent, waiver and release of liability and understand all of its terms. I execute it voluntarily and with full knowledge of its significance. I expressly agree that this release shall be binding upon my heirs, executors, administrators and assigns.

Signature:____________________________

Date:____________

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Then mail the completed form to:

Oakbrook Swim & Tennis Club, Inc.
P.O. Box 1385
Florence, KY 41022-1385