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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 |
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