Name *

First Name

Last Name

Phone *

(###)

###

####

Hold Harmless Agreement: *

I/we its officers, employees and members shall, by hitting agree to this Agreement by an authorized party or agent, indemnify, hold harmless and defend the Town of Pima, Pima Volunteer Fire Department and its agents, and employees from all suits and actions, including reasonable attorneys' fees and all costs of litigation and judgment of every name and description against the Town and Fire Department as a result of loss, damage or injury to person or property by reason of any action or omission by the Town of Pima, Pima Volunteer Fire Department, its agents or employees, for the following event

I/we Agree to the Hold Harmless Agreement