Dayton Diode Wiki
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'''Name:''' ___________________________________________
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'''Name:''' __________________________________________
   
 
'''Address:''' _________________________________________
 
'''Address:''' _________________________________________
   
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_________________________________________________
_________________________________________
 
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_________________________________________________
   
 
'''Phone number:''' _________________________
 
'''Phone number:''' _________________________
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'''Email address:''' ___________________________________
 
'''Email address:''' ___________________________________
   
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<u>'''Initial each of the following:'''</u>
__ '''I have read and agreed to abide by the [[Dayton Diode Charter]].'''
 
   
__ '''I have read and agreed to abide by the Membership Agreement.'''
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______ '''I have read and agree to abide by the [[Dayton Diode Charter]].'''
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______ '''I have read and agree to abide by the [[Dayton Diode Membership Agreement|Membership Agreement]].'''
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______ '''I have signed the [[Limit of Liability Form|Liability Waiver]].'''
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'''Applicant Signature:''' ___________________________________ '''Date:''' ____________
   
__ '''I have signed the Liability Waiver.'''
 
   
'''Applicant Signature:''' ____________________________________ '''Date:''' ____________
 
   
__ '''Applicant has been approved by present members.'''
 
   
 
'''Officer Signature:''' _______________________________________ '''Date:''' ____________
 
'''Officer Signature:''' _______________________________________ '''Date:''' ____________
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Licensed under [http://creativecommons.org/licenses/by-nc-sa/3.0/ Attribution-Noncommercial-Share Alike 3.0 Unported] based on the [http://wiki.hive13.org/Membership_Application Hive 13 Membership Application]
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Consensed on by Dayton Diode membership on Nov 2, 2010.
 
[[Category:Membership]]
 
[[Category:Membership]]

Latest revision as of 22:35, 15 October 2014

Name: __________________________________________

Address: _________________________________________

_________________________________________________

_________________________________________________

Phone number: _________________________

Email address: ___________________________________

Initial each of the following:

______ I have read and agree to abide by the Dayton Diode Charter.

______ I have read and agree to abide by the Membership Agreement.

______ I have signed the Liability Waiver.


Applicant Signature: ___________________________________ Date: ____________



Officer Signature: _______________________________________ Date: ____________


Licensed under Attribution-Noncommercial-Share Alike 3.0 Unported based on the Hive 13 Membership Application


Consensed on by Dayton Diode membership on Nov 2, 2010.