Membership Application

The undersigned hereby applies for membership in the Roxboro Valley Association, Inc (RVA) on behalf of the family members listed below. It is further understood that this application is made subject to the acceptance of the Board of Directors of Roxboro Valley Association, Inc. A non-refundable fee of $50 is required to submit this application. Checks should be made out to RVA and mailed to PO Box 12391, Atlanta, GA 30355. You will not be added to the waitlist until your application fee has been received.

Name of applicant(s): *
Dependent children & ages:
Address: *
Home phone: *
Work phone:
Email address(es): *
Type of Membership desired:

I acknowledge that I received, read and agree to abide by RVA's Rules and Regulations as set forth here and as may be amended from time to time.
Email address: *
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This application is endorsed and recommended by the following current RVA members (2 required):
Reference 1 Name & Email: *
Reference 2 Name & Email: *

All use of RVA property shall be undertaken by a member or guest at his/her sole risk. RVA shall not be liable for any injuries and or damage to any member or guest, or the property of any member or guest, or be subject to any claim, demand, injury or damages whatsoever, including, without limitation, those damages resulting from acts of active or passive negligence on the part of RVA, its officers or agents. The member host is responsible for the conduct of his/her guest. Each member shall be liable for all breakage or damage to any property or persons as a result of the negligence or misconduct of the member, his/her family members or guests. The member, for himself/herself and on behalf of his/her executors, administrators, heirs, assigns and successors, does herby expressly forever release and discharge RVA, its 
owners, officers, employees, agents, assigns, and successors from all claims demands, injuries, damages, actions or causes of action.