Lake of the Ozarks Swing Dance Club
Membership Application & Renewal Form




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Please Print:
Name        _________________________  ___________________________  Today's Date  
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Address     _____________________________________________________  Birth Month/Date
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City           ________________________________________  State  ________  Zip Code   
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E-Mail Address  
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Phone (Home)    ___________________________  (Other)  
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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
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Expiration:_______
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First Name                                              Last Name
LOSDC
%M
arty Aerne
1
014 Waldo Lane
S
t. 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