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:
==================================================================================================
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: _____________________________________________________________________
==================================================================================================
This section will be completed by membership personnel.
____ New Membership ____ Cash
____ Renewal ____ Check No. ____ Other
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:
==================================================================================================
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: _____________________________________________________________________
==================================================================================================
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
-- Quarterly newsletter
-- Reduced admission to LOSDC and sister club dances
-- Admission into all local sister club events at their member
prices
Membership
#_______
Expiration:_______
___
#_______
Expiration:_______
___
First Name Last Name
LOSDC
%Marty Aerne
1014 Waldo Lane
St. Charles, MO 63304
%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
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
 |
 |
 |
 |
 |
 |
 |
 |
 |