Membership Application
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Name________________________________________________ |
New Member _ Renewal _ |
Address____________________________________________________________________
City_____________________________State_______________ ZIP_____________
Home Phone________________ Work Phone_______________ Occupation
__________
(not required info)
|
Month/day |
|
Birthdate________/________ Female _ Male _ Married? Yes _ No _ |
How did you learn about the CINCINNATI BOP CLUB?_____________________________
Are you interested in dance lessons? Yes _ No _
Specify __________________________
Would you be interested in serving on a Committee?
Hospitality
_ Dance Floor _
Registration _ Sales _
Split the Pot _
Please read this statement before
signing the application:
The Cincinnati Bop Club is dedicated to
the promotion and preservation of JITTERBUG, BOP, SWING and SHAG dancing and to
the RHYTHM AND BLUES music that gave these dances their start. The type of
music we play is the cornerstone of this club and WILL NOT be expanded to
include "Oldies, Disco, Country or the Flavor of the Week."
CBC Privacy Statement
The CBC does not disclose, sell, rent, lease, or
publish member’s personal information to third parties unless required to do so
by law or in the good faith belief that such action is necessary.
RELEASE FROM LIABILITY
In
consideration of being permitted to participate in any activities conducted by
the Cincinnati Bop Club, releasor for himself, his spouse, legal
representatives, heirs and assigns, hereby releases, waives and discharges the
Cincinnati Bop Club, its officers and members, and each of them from all
liability to releasor, releasor’s spouse, legal representatives, heirs and
assigns, for any and all loss or damage and any claim or damages resulting
therefrom, on account of injury to releasor’s person or property, even injury
resulting in death of the releasor, whether caused by the negligence of
releasees or otherwise, while the releasor is for any purpose participating in
any activity or function sponsored by the the Cincinnati Bop Club. Releasor hereby agrees to indemnify the
releasees and each of them from any loss, liability, damage or cost they may
incur due to the presence of the releasor at any activity or function sponsored
by the Cincinnati Bop Club, whether caused by the negligence of the releasees
or otherwise. Releasor hereby assumes full responsibility for the risk of
bodily injury, death or property damage due to the negligence of releasees or
otherwise while for any purpose participating in any activity or function
sponsored by the Cincinnati Bop Club. Releasor
expressly agrees that this release, waiver and indemnity agreement is intended
to be as broad and inclusive as permitted by the laws of the State of Ohio and
the Commonwealth of Kentucky and that if any portion hereof is held invalid, it
is agreed that the balance shall notwithstanding continue in full legal force
and effect.
IN WITNESS WHEREOF, releasor has executed this
release on the day and year written below.
Signature
______________________________________Date_____________________________
Dues: New Member $36.00
(Pro-rated each month thru Oct.)
Renewal $25.00 Until January 31
Renewal $30.00 After January 31
SNAIL
MAIL TO: P.O. Box 62552,
Cincinnati, OH 45262-0552