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 or $20.00 for semiannual membership per person to:

Music City Bop Club Treasurer P.O. Box 604 Goodlettsville, TN. 37070