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Please complete, sign, date and include with your check made out to the
"Brookline Bird Club, Agent"
for each Pelagic trip you join. Thank you.
 

I agree not to hold any of the leaders, coordinators, or the Brookline Bird Club responsible for any injury I may sustain on the Pelagic trip aboard the Helen H on:

Date of Trip ____________________________
 
___________________________________________________________________________
Name(s), printed      
 
___________________________________________________________________________
Signatures of all participants require.
 
Date: ______________________________
 
E-mail address: ______________________________________________________________
 
Phone number:_______________________________________________________________

 

To register for a pelagic trip(s), send payment in full along with a signed waiver to:

Ida Giriunas
83 Summer Avenue
Reading, MA 01867

Make checks payable to ‘Brookline Bird Club, Agent’ and specify the trip you are registering for. If you register for more that one trip, enclose SEPARATE CHECKS and SIGNED WAIVERS for each. Also, you MUST INCLUDE your email address or a self-addressed stamped envelope for confirmation and further information.

Signed waivers are mandatory for pelagic trips.
Contact Ida at 781-944-5135 or ida8@verizon.net

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