Dayton Diode Wiki
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'''Name:''' ___________________________________________
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'''Name:''' __________________________________________
   
 
'''Address:''' _________________________________________
 
'''Address:''' _________________________________________
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'''Applicant Signature:''' ____________________________________ '''Date:''' ____________
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'''Applicant Signature:''' ___________________________________ '''Date:''' ____________
   
   

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.