SPACE COAST DANCE CLUB
New Membership Application/Renewal Form
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* First Name:  
* Last Name:  
Is this a Renewal?
*First Name and Last Name are Required Fields*
Today's Date:
Address:
Apt No.:
City,St,Zip:
Birth Month:
Home Phone:
Cell Phone:
Email:
YOUR INFORMATION IS FOR SCDC USE ONLY. IT WILL NOT BE SHARED.
Please indicate if you would like to volunteer for any of the following:
Advertising/Publicity:
Host/Hostess (dancing with un-partnered attendees):
Outreach:
Social Greeter (welcoming newcomers):
Activities Participation:
In consideration for being allowed to participate in Space Coast Dance Club (SCDC) events, I release SCDC, its
respective officers, directors, members, instructors, other participants and the Fraternal Order of Police
(FOP) from liability and waive the right to sue for any and all claims, including but not limited to, claims of
negligence, resulting from any physical injury, loss or damage to personal property, illness (including death)
or economic loss or costs which may result from participation in the SCDC event, travel to and from the event
or any activities incidental to the event. I agree to indemnify SCDC, its respective officers, directors,
members, instructors, other participants and the FOP from any and all liability claims and causes of action
connected with participation in this SCDC event. I take full responsibility for my behavior and for any damage I
may cause to the facilities, other participants, or their personal property. I agree to abide by the SCDC Rules
of Conduct found at
http://www.spacecoastdanceclub.com/conduct.html and I grant SCDC permission to
utilize photographs and /or videos of me, for advertising and publicity purposes.  
 
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SPACE COAST DANCE CLUB, INC (SCDC) is organized and operates as a nonprofit social and educational
organization under the Nonprofit Corporation Act (the “Act”) for the purpose of preserving, studying, teaching and
promoting public interest in all forms of social dancing.  SCDC shall not engage in any activity that conflicts with its
status as a nonprofit corporation.
 
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Dances are held at:
FOP, 1049 Julia Drive, Melbourne, FL  32935
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Space Coast Dance Club mailing address is:
Space Coast Dance Club, 802 Ridge Lake Drive., Melbourne, FL  32940

Space Coast Dance Club telephone:321-544-5160

Space Coast Dance Club Email Address:
spacecoastdanceclub@yahoo.com

Space Coast Dance Club Website: WWW.SPACECOASTDANCECLUB.COM

Copyright (C) 2011 Space Coast Dance Club All rights reserved.