TCA-ROLLING STRONG

Landstar

DRIVER WELLNESS PROGRAM ENROLLMENT

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Membership & Payment Details:

Total cost: one time fee of $22.60 for annual membership.

A Rolling Strong Enrollment Specialist wil contact you for payment once you submit this form. Make sure to enter a valid phone number and email.

Authorization for Payment to Rolling Strong, I agree to abide by the following:

I understand and agree that this driver wellness membership will begin on the date that this agreement is signed. My payment of $22.60 is for one annual membership.

I am aware of the risks of illness or injury inherent in any exercise and wellness activity. I am participating in the TCA-Rolling Strong Wellness Program upon the express understanding that I hereby indemnify, defend, waive and release Landstar and TCA Wellness, its employees, agents, officers, directors, successors, and assignees from any and all claims, costs, liabilities, expenses or judgments, including attorney’s fees and court costs arising out of my participation or any illness or injury resulting there from. Before participating in any new exercise program, I understand I should consult with my physician.

Typing your name below signifies your signature and agreement to the fees and information above.