Boots ‘n’ Buckles Dance Club

Membership Application / Renewal Form

Current Memberships Expire August 31st

Membership - $18.00

Annual Membership dues are payable when you join or renew.

Membership is from September 1 through August 31.

New members joining from October through August in

the current year will be entitled to a prorated amount.

Benefits of membership in the best dance club west of the Pecos:

 $2.00 discount to the Friday night dances at Boots ‘n’ Buckles

 One free admission in the anniversary month of your birth

 Eligible to vote at General Membership Meetings

 One 'Name Your Dance' Card on your birthday

 Occasional ‘Free Admission’ Raffles (for Members Only)

 Supports the club and keeps us dancing!

Turn in this form to the cashier with your cash or check, OR mail your check to:

Boots ‘n’ Buckles / P.O. Box 3225 / Fremont, CA 94539

Make your check payable to “Boots ‘n’ Buckles”. Please do not mail cash.

□ New Member □ Membership Renewal □ Name/Address Change only

(Please Print) (Month/Day) Amount

Your Name: Birthday( / ) $

Spouse/other: Birthday( / ) $

Address: Total $

City: State: Zip:

Phone number: ( ) - Email:

Release of liability: The undersigned accepts to make no claims against Boots ‘n’ Buckles Dance Club, the venue, or any of its officers, employees, D.J.’s, instructors or volunteers for any injury or illness or theft arising from this activity, however caused. You, for yourself and for your heirs, legal representatives and assigns, in consideration for services rendered and to be rendered by Boots ‘n’ Buckles Dance Club, hereby covenant with the venue, and all of the agents, employees, sponsoring agencies, and subcontractors of California, to never institute any suit or action at law or in equity against Boots ‘n’ Buckles Dance Club, the venue, any affiliates, dance instructors, D.J.s, and club officers by reason of any injury you may hereafter acquire relating to your participation in the dances and/or lessons or as an observer. You will take full responsibility for your actions. You may be asked to leave the venue if you become harmful to other patrons or the premises or are perceived as such.

Signature: Date:

Spouse Signature: Date:

For Boots ‘n’ Buckles Use Only

Received Date: / Amount Received: $______
Processed by: / £ Cash
Membership period: 9/01/20____-8/31/20____ / £ Check Number ______
ICE on file? £ Yes / Notes: Rev. 1.04.18