Dayton Diode Wiki
Register
No edit summary
No edit summary
Tag: Visual edit
(One intermediate revision by one other user not shown)
Line 1: Line 1:
'''Name:''' ___________________________________________
+
'''Name:''' __________________________________________
   
 
'''Address:''' _________________________________________
 
'''Address:''' _________________________________________
Line 21: Line 21:
   
   
'''Applicant Signature:''' ____________________________________ '''Date:''' ____________
+
'''Applicant Signature:''' ___________________________________ '''Date:''' ____________
   
   

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.