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. Please PRINT legibly and fill out completely.
Name________________________________________________Date____________ Street Address_________________________________________Apt#____________ City_____________________________________State_________Zip_____________ Phone___________________________________________Birthday Month___ Email Address__________________________________________
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: Communications/Publicity__________ Dance Host/Hostess (dancing with unpartnered attendees)__________ Community Events__________
Social Greeter_________(Welcoming newcomers)
In consideration for being allowed to participate in this Space Coast Dance Club (SCDC event, 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 and I grant SCDC permission to utilize photographs and / or videos of me for advertising and publicity purposes.
Signature______________________________________________________________
Membership dues are $30 per calendar year. Make check payable to Space Coast Dance Club, Inc. Apply at an SCDC event or by mail to: Space Coast Dance Club, PO Box 410664, Melbourne FL 32941
