Services

Lake of the Ozarks Swing Dance Club

Membership Application & Renewal Form

__________________________________________

Please Print:

Name _________________________ ___________________________ Today's Date ________________

Address _____________________________________________________ Birth Month/Date ____________

City ________________________________________ State ________ Zip Code _________________

E-Mail Address

__________________________________________________________________________________________

Phone (Home) ___________________________ (Other) _______________________________________

Would you like to volunteer? ____ YES ____ NO

I would like to help with: ____ Decorations ____ Dance Set Up ____ Newsletter ____

Membership or Lessons Table_______

____ Copies ____ Hotline ____ Website ____ Photography

____ Other

Mail this form

with your remittance to:

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I agree, by my signature below, that I and my heirs, legal representative and assigns, hereby release, waive, and discharge the Lake of

the Ozarks Swing Dance Club, its members, directors, coordinators, teachers and other officers from all liability to my person or

property, including injury and/or death incurred while participating in any Club activity or other activity appearing in the Club newsletter or

Website. I agree that this release, waiver, indemnity agreement is intended to be as broad and inclusive as permitted by the laws of the

State of Missouri and that if any portion hereof is held invalid, it is agreed that the balance shall continue to be in full effect. I further

understand that the information on this form is solely for the use of the LOSDC and that my personal information will not be distributed as

part of a list for use outside the Lake of the Ozarks Swing Dance Club.

Signature: _____________________________________________________________________

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This section will be completed by membership personnel.

____ New Membership ____ Cash

____ Renewal ____ Check No. ____ Other

PERKS FOR ALL NEW MEMBERS & RENEWALS

-- Quarterly newsletter

-- Reduced admission to LOSDC and sister club dances

-- Admission into all local sister club events at their member

prices

Membership

#_______

Expiration:_______

First Name Last Name

_______________________________________________________________________________

LOSDC

%Marty Aerne

1014 Waldo Lane

St. Charles, MO 63304

Annual Dues $20.00

Make Checks Payable To: LOSDC

Initial Membership only: June to Dec.

$20.00, Dec. to May $10.00

Renew through June 30 $15.00 after

July 1 $20.00 to renew