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Download Membership Renewal Form
The Coasters Rock ‘n’ Roll Club Inc
Membership Application/Renewal 2017
Name……………………………………………………………………………
Contact Address………………………………………………………………
Mobile………………………………………………………………………….
Email……………………………………………………………………………
Birthday……………………………………………………………………
Condition of entry
I accept there is an inherent risk in any physical activity, including rock and roll dancing.
I accept full responsibility for any injury that I may sustain while rock and roll dancing as a member or guest of the Coasters Rock ‘n’ Roll Club Inc.
I undertake to limit this risk by making club executive aware of any injuries or illness and by taking reasonable steps to limit the risk of further illness or injury.
Declaration
I undertake to abide by the rules and constitution of the Coasters Rock ‘n’ Roll Club Inc and understand that voting rights are only granted to financial members.
Publicity
I give/do not give permission for my image to be used for publicity purposes in print and/or digital media.
Annual subscription due 1 April.
Signed…………………………………………. Date…………………………
Office use: Date joined: ……………………………… Paid………………………………
membership renewal form 2017