Membership and Renewal
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.
Dance Club at the University of Hawaii/Manoa
P.O. Box 12170
Honolulu, HI 96828
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.