Membership and Renewal Application
Dance Club at University of Hawaii/Manoa

It's EASY to become a member of Dance Club!
Simply print this page, fill in the requested information, and mail it back to us with your dues.

Mailing Address:
Dance Club at the University of Hawaii/Manoa
P.O. Box 12170
Honolulu, HI 96828

E-mail: uhdance@hawaii.edu
Web: http://www2.hawaii.edu/~uhdance

DC Membership 2000 - 2001

Current students of UH/Manoa, Community Colleges, and all State/Private High Schools...$10.00 per year.
All others...$12.00 per year.

Name:________________________________________________________________
	Last			First				MI

Mailing Address:_____________________________________________________
			Street Name			Apt. #

		_____________________________________________________
			City			State		ZIP

E-mail address:________________________

Tel:___________________

Fax:___________________

Gender (please circle):  M___  F___  Social Security #: _____ - ____ - _______

Marital Status (please circle): S__ M__ D__ W__   ___________________
						                          Date of Birth (opt.)

MEMBER'S PARTICIPATION
----------------------

The DANCE CLUB at University of Hawaii/Manoa is a non-profit
organization.  All its programs, excluding dance instruction, are
performed by volunteer members.  Each member is encouraged to
contribute his/her skills, talents, or time to the organization by
serving on a committee.  Kindly take a moment to advise us of your
availability and area(s) of interest and/or expertise that could be
mutually beneficial to the Dance Club and its members.

___Membership  ___Computer  ___Accounting  ___Public Relations

___Event Coordinator  ___Music  ___Special Events  ___Production

___Other (please specify):___________________________________________


Membership in the DANCE CLUB is open to anyone interested in dance or
learning to dance, irrespective of age, sex, religion, or
ethnic background.  Membership is valid for one (1) year from the
start of the fall semester to the last day of summer session.  Dues
must accompany application.  Kindly make checks payable to:
Dance Club at University of Hawaii/Manoa and mail to the above
address.  If paying by credit card, please include the following information:

Charge my	___Visa		___Mastercard

Card No.____________________________________  Exp. Date:_____________


SURVEY DANCE PROGRAMS
---------------------

Below kindly rate your dance preferences on a scale of 1-12 with
#1 being the most prefered dance style.

My favorite dances are:

___Waltz  ___Fox Trot  ___Jive  ___East Coast Swing  ___Shag
___Samba  ___Charleston
___West Coast Swing  ___Lindy Hop  ___Shim Sham  ___Jitterbug Stroll
___Balboa
___Line Dances  ___Country Western  ___Nite Club 2-Step
___Latin/Salsa  ___Merengue  ___Cha Cha Cha  ___Cumbia  ___Lambada
___Paso Doble  ___Rumba
___Other (please specify):___________________________________________


ASSUMPTION OF RISK AND RESPONSIBILITY
-------------------------------------

I, ________________________________________, understand that there
are inherent risks involved in my participation in the Dance Club
at University of Hawaii at Manoa (DC), including risk of property
damage, personal injury, and death.  I understand that the State
of Hawaii, University of Hawaii at Manoa, and their officers, agents,
and employees, or representatives and the DC's officer agents, or
representatives do not provide liability insurance, or otherwise
indemnify me against injuries or any other liabilities arising from
my participation in the DC, at the University of Hawaii at Manoa.
Therefore, in consideration of my being permitted to participate in
the DC, I assume the risk and responsibilities surrounding my
participation in the DC's activities.  I release, agree to defend,
hold harmless, and indemnify The State of Hawaii, University of
Hawaii at Manoa and their officers, agents, employees, or
representatives and the DC's officers, agents or representatives
from and against all liabilities, claims, demands or cause of
actions including claims for property damage, personal injury, or
death caused by the passive or active negligence of myself and/or
The State of Hawaii, University of Hawaii at Manoa or its officers,
agents, employees, or representatives and the DC's officers, agents,
or representatives arising our of my participation in the DC at
The University of Hawaii at Manoa.

I have read, understood, and agree with this risk/release waiver.

________________________    ___________________________   ___________
Participant Signature	    Parent/Guardian (under 18)       Date




FOR OFFICAL USE ONLY
--------------------

Date approved:___________________   Payment:_______________________

Amount:__________________________   Computer Log:__________________

E-Mail Log:______________________   M/Number:______________________

M/Exp. Date:_____________________

PLEASE NOTE:
Membership processing takes fourteen (14) days after receipt of
membership dues.  Applicants will be notified via e-mail, fax,
or regular mail confirming Dance Club membership.