Application
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Membership Application



Orange County Sansei Singles Membership Application
(Also for change of address & phone number form)

RENEWAL _____ NEW APPLICANT _____
Please check if new address/phone number _____
Name: ________________________________________
Address: _____________________________________
City, State & Zip: ___________________________
Phone: _______________________________________
e-mail address: ______________________________
Best time to call: ___________________________
Birthday (Month/Day): ________________________
Person who introduced me to the club: ________
______________________________________________
Activities I would be interested in (examples
dancing, lectures, plays, sports, etc):_______
______________________________________________
______________________________________________
I do not permit (mark your choice(s)):
my name ______, address ______, phone ________
to be included in the OCSS Directory.
_____ my check for $20.00 made payable to OCSS
is enclosed.

RELEASE WAIVER OF LIABILITY
The Orange County Sansei Singles Club is a year-round
social club providing a variety of activities for its members.
Many of the activities are to a varying degree hazardous.
By applying for membership, I voluntarily assume the risks
involved, and I agree not to hold the Orange County Sansei
Singles Club or its officers and Board members liable for any
accidents or injury resulting from my participation in any club
activity. After reading and understanding this Relase of
Liability, I voluntarily sign this release and hereby apply for
membership in the Orange County Sansei Singles Club.

_______________________________________________
Signature

_______________________________________________
Date

Mail check and application/waiver form to OCSS,
c/o Membership, P.O. Box 3102, Cerritos, CA
90703-3102

OCSS Home Page