MUSIC CITY BOP CLUB MEMBERSHIP APPLICATION

In order to maintain an accurate record of our membership, please provide the following information:

NAME:___________________________________________________________________________________

ADDRESS:________________________________________________________________________________

CITY:____________________________________________________STATE:_________ZIP:______________

TELEPHONE: (home)__________________________________(cell)_________________________________

DATE OF BIRTH:(month/day ONLY)____________/____________FEMALE:______MALE:_______

If you want to get the weekly email update, please PRINT your email address:

Email:___________________________________________________________________________________

MARRIED: YES_____NO_____ NEW MEMBER:__________RENEWAL:___________

DATE PAID:______________AMOUNT PAID:____________ PAID CASH:___CHECK:___

Are you interested in learning to Bop? YES______NO_______ Already know how___________
 
Release From Liability
In consideration of being permitted to participate in  activities conducted by the Music City Bop Club, Inc., the undersigned "Releasor" hereby releases, waives, and discharges the Music City Bop Club, it's officers, and members from any and all claims for loss, injury, or damage to person or property incurred during, or preparing for, any club activities, whether caused by negligence or otherwise. Releasor hereby assumes all risk of loss or damage from injury or damage to his or her person or property incurred during, or preparing for, any club activities. This agreement is binding upon any legal representatives, heirs, and assigns of the Releasor. Laws of the State of Tennessee govern this agreement. Releasor agrees that the courts of Davidson County, Tennessee shall have exclusive jurisdiction and venu to resolve any controversy or claim to which this release may apply.

     Releasor:___________________________________    Date:______________

    The Music City Bop Club is an organization of volunteers operating through committees that do the work of our nonprofit corporation. Members are encouraged to help out by serving on a committee. Please indicate any committees on which you would be willing to serve. Rank your choices 1, 2, etc.
________ A. Hospitality, ticket sales and entertainment
________ B. Decorations and food
________ C. Membership and Business Directory
________ D. Communications and Publications
________ E. Charity functions
Please send your check for membership dues, in the amount of  $35.00 for annual membership.
Music City Bop Club Treasurer
P.O. Box 604
Goodlettsville, TN. 37070