Membership

Membership Type*
- Couple
- Individual
- Full-Time Student
- Active-Duty Military
Please select the applicable membership type. Students must be full time pre-school through graduate. Military must be active duty.
Status*
- New Member
- Renewing Member
School Name*

Enter the name of the school where you are a full-time student.
Military Station*

Please enter the name of the location where you are stationed and the branch of the military.
Member Name*
First Last
Second Member Name*
First Middle Last
Please enter the other name of the couple.
Email*

Please enter the email address that we should use to contact you.
Phone Number*
Please enter the phone number we can use to contact you.
Waiver
In consideration of the right to participate in this activity, I waive and release any and all rights and claims for damage I may have against the Ballroom Dance Club of Fairbanks, its board, employees, instructors and agents, for any and all injuries suffered by me while participating in this activity unless such injury is caused by gross negligence.

I give my consent to emergency treatment, including hospitalization as may be needed for my welfare.
Agreement to Waiver*

Please type your full name to agree to the above waiver.
Comments
Please enter any other information you'd like us to have.
Total
$0.00

SKU: membership Category: Donations

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