Indemnification Statement

The undersigned, (Enter FULL Legal Name)

as a (check one)

duly nominated and elected member of the Fernandina Pirates Club, Inc. (the Club), in consideration for having been voted into membership in the Club and as one of the conditions to instituting and/or maintaining my membership in good standing,Option 1

non-voting "Swabbie" who is permitted to participate in Club activities without having to attain full membership in the Club and as one of the conditions to instituting and/or maintaining limited participation in good standing,Option 2

I understand and agree that the primary purposes of the Club is to promote the annual Isle of Eight Flags Shrimp Festival and in furtherance of such promotion, Club members frequently appear in pirate costume at Club sanctioned parades and similar public events. I also understand the purpose of the Club is to serve the community and promote pirate history in the Fernandina Harbor area.

I further understand and agree and that Club does not require that members who appear in costume at public events carry weapons of any nature, either authentic weapons or replicas.

I acknowledge that I have received and read a copy of the General Safety Rules, Firearms Regulations, Bylaws, Policies and Procedures and any other rules the Club may promulgate in the future. I understand and agree to abide by any such rules.

I further understand and agree that the Club does not endorse any third party weapons training or instruction to which I may choose to subscribe or in which I may choose to enroll.

Although the Club makes no representation to me to the validity of any third party training, I do understand that the Club strongly recommends that I make every effort to become thoroughly educated in the use of any weapon I may choose to carry while in costume.

I fully agree to personally accept responsibility and liability for my actions and to indemnify, hold harmless and defend the Club from any loss, damage, expense, claim, cause of action and/or liability that may arise from any action I may take while participating in a Club sanctioned event or at any public or private event or occurrence at which I hold myself out to be a member of the Club.

By signing this form I give the Fernandina Pirates Club permission to do a background check on me before being voted in as a Pirate. I understand that the purpose is to reveal to the Club if l have been convicted of being a pedophile, sexual predator, child or spousal abuser, have excessive DUI's, excessive disorderly conduct charges or convicted of any felony that could negatively affect the reputation of the Fernandina Pirates Club or be a danger to any other member or the public.

Dated This

Day of

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Address

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Birth Date:

I authorize the Fernandina Pirates Club, Inc. ("Club") to have background check performed on me and agree to read the Bylaws and Policies and Procedures of the Club. PLEASE TYPE IN YOUR NAME FOR SIGNATURE