ST. CHARLES SINGLES CLUB, LTD.

Proudly Celebrating Our 31st Year

Join us for Dancing & many other Special Activities

Membership Application

____New      ____Renewal

Dues are $25.00 per year. Renewals are due on or before your annual anniversary date!

Name:                                                                             Name:                                                                    

Address:                                                                        Telephone:(         )                                                    

City:                                                                                Relationship:                                                            

State:           Zip Code:                                                   E-mail address:                                                          

Telephone:(         )                                                         Cell Phone:(         )                                                     

Birth Date, Month:                      Day                             Male                  Female            

The club is run entirely by volunteers; assistance is always needed and welcomed.

I give permission for photos that may include me in them to appear on the SCSC Web Site.

Waiver: In consideration of being permitted to join the St. Charles Singles Club of St. Charles, Illinois, and/or participate in its events or activities, I, on behalf of myself, my heirs, personal representatives or assigns, do hereby release, waive, discharge, hold harmless and covenant not to sue the St. Charles Singles Club, its officers, committee chairpersons, members, invited guests, speakers and agents from liability from any and all claims including the negligence of St. Charles Singles Club, its officers, committee chairpersons, members, invited guests, speakers and agents resulting from personal injury, accidents or illnesses (including death), and property loss arising from, but not limited to, membership in and/or participating in any St. Charles Singles Club’s events or activities. I acknowledge I have read and fully understand the waiver and release of all claims. I am signing the agreement freely and voluntarily and intend my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law. Participation will be denied if your signature and the date are not on the Membership Application. To participate in an activity or event, your signature and the date must be on the appropriate Sign-up sheet.

Signature:                                                                           Date:                                                                        

Mail application with check or money order payable to St. Charles Singles Club, Ltd. at address below:

St. Charles Singles Club, Ltd.

P.O. Box 54

St. Charles, Il. 60174-0054