Membership Registration

Pickleball Mississauga Association (PMA)

Affiliated with the City of Mississauga Recreation and Parks Division

Member of the Mississauga Sports Council

Member of Mississauga Senior Council



                                                            Membership Registration

Name: (Mr / Mrs / Ms) _____________________________________________ M / F (circle)

Address: ____________________________________________________________________

City ____________________________ Postal Code _____________ Year of Birth _________

Email ___________________________________________ Phone _____________________

Health Declaration

I consider myself physically able to participate in Pickleball and will assume all risks associated with playing Pickleball.  My doctor has recommended such physical activity.

Medical Authorization

I accept responsibility for my own medical coverage. I give permission to staff and volunteers with the City of Mississauga or PMA to arrange for any emergency care including hospitalization and transportation if necessary, and I agree to pay for all expenses and costs incurred thereby. 

Waiver of Liability

I release and waive all claims and hold harmless PMA, the Corporation of the City of Mississauga, as well as any venue where PMA might play, including their elected officials, officers, employees, agents, representatives, volunteers and any other participants, for any liability, property damage or personal injury resulting to me.

Disclosure Statement

I agree my personal information limited to email address and telephone number can be shared within the PMA and its members without my prior consent. Any other personal information must remain confidential for use by PMA only and for its intended use.

Would you like to become a volunteer?   Yes ______  No ______ 

I have read and understood the health declaration, medical authorization, waiver of liability and disclosure statement as listed above.

Signature: ____________________________________________________________


Date: _____________________




Annual Membership Fee: $5.00

Valid until August 31, 2018

PAID: $_________

PMA-membership-form (2017-09)





Rene St. Cyr,
Sep 14, 2017, 6:42 PM