Name *

First Name

Last Name

Phone *

(xxx)-xxx-xxxx

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I understand that binding system cannot guarantee the user's safety. In downhill skiing with release bindings the binding system will not release at all times or under all circumstances where release may prevent injury or death, nor is it possible to predict every situation in which it will release. I understand that the sport of skiing involves inherent and other risks, of INJURY or DEATH. I voluntarilly agree to expressly assume all risks of injury or death that may result from recreational snow sports or which relate to the use of this equiptment. I AGREE TO RELEASE AND HOLD HARMLESS Black Crows, and Sales reps including L. Fernandes and his associates, equiptment manufacurers, and distributors and their successors in interest, from all liability for injury, death or property loss and damage which results from the equipment user's participationin the Recreational snow sports for which the equipment is provided or related to any use of this equipment, including all liability which results from the NEGLEGENCE of PROVIDERS or any other person or cause. I further agree *

lawyer stuff

I understand / agree with above statement

todays date *

MM

DD

YYYY

users electronic signature

I have accurately reported the above information and it is true and correct