Northern Utah Prospectors Association (NUPA) Membership Form

All Members (and where applicable, family members and guests):

Shall follow the Miners Code of Ethics (posted on the NUPA website: http:www.nupainc.org)

Are solely responsible for the actions of family and/or guests

Shall become familiar with and follow all Federal, State and local laws pertaining to prospecting

Shall secure and follow Forest District laws and rules for the respective prospecting location

Any violation of the above, with or without citation, will cause the immediate revocation of membership in NUPA with no recourse.

Any member expelled from NUPA under this agreement shall hold NUPA, its Board of Directors and any current/active member in NUPA harmless.

Board of Directors of NUPA, 19 December 2012

NUPA Gold Prospectors Association Waiver

I, the undersigned, waive any claim for injury, theft, loss, or any other damage to me or to a member or members of my family and/or any guests. I understand that this agreement between me, my family and/or guests and NUPA shall indemnify and hold harmless NUPA and any and all members, officers, successors and affiliated persons and groups from any and all actions, claims, demands, lawsuits, liabilities, losses, damages, judgments and other expenses incurred or suffered while traveling to and from any claim, while working on any claim or while participating in any NUPA sponsored outing. I agree to hold harmless any/all owners or leaseholders of any NUPA land use properties. I agree that I shall be responsible for damage to any of my equipment that may occur while prospecting and/or mining on any NUPA claim or land use property.

Signature: ___________________________________________________ Date: __________________________________

Print Name: _________________________________________________

Spouse & Children’s Names: _________________________________________________________________________________

Address: _________________________________________________________________________________________________

City: ________________________________________________________ State: ______ Zip Code: _________________

Phone: ______________________________________________ Email: ______________________________________________

Witness: _____________________________________________ Date: __________________________________

Please sign the fully completed form at a meeting or mail with your membership dues to NUPA, P.O. Box 13301, Ogden, UT 84412.

Dues: New Member $40.00 Renewal: $30.00 Mailed Newsletter: +$5.00