Name: ___________________________________________
Address: _________________________________________
_________________________________________________
_________________________________________________
Phone number: _________________________
Email address: ___________________________________
__ I have read and agreed to abide by the Dayton Diode Charter.
__ I have read and agreed to abide by the Membership Agreement.
__ I have signed the Liability Waiver.
Applicant Signature: ____________________________________ Date: ____________
__ Applicant has been approved by present members.
Officer Signature: _______________________________________ Date: ____________
Based on the Hive 13 Membership Application