EmailMe Form - TBWCSA Annual Membership Form

Name *

First Last

Email *

Phone *

### - ### - ####

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Do you have any skills or talents (besides dancing) that you would like to offer to TBWCSA?

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Liability & Indemnity Waiver

By electronically signing below and in consideration of being permitted to participate in activities of the Tampa Bay West Coast Swing Association, Inc. (“TBWCSA”) I hereby waive, release and forever discharge  TBWCSA and all of its officers, directors, contractors, employees, owners, lessors and agents from any and all liability for any reason whatsoever.  I understand and agree that such participation may cause injury to me and that there may be dangerous conditions at the facilities where TBWCSA activities take place and I hereby fully assume all risks of taking part is such activities and being at such facilities.  I agree to indemnify and hold harmless all of the aforesaid released parties from and against all loss and costs, including reasonable attorney fees, which may be caused in whole or in part by my taking part is such activities and presence at such facilities.  I hereby authorize TBWCSA to use photographs and/or videos of me in TBWCSA publications, websites and when promoting activities of the TBWCSA, and understand that TBWCSA will do its best to remove any photographs or videos of me at my request.

I represent and warrant that I am the person named above, and confirm this by typing my name as my electronic signature in this box.

**Please type your full name in the box to confirm this.** *

Date *

MM / DD / YYYY

Membership Annual Fee

Adults over 21 = $40
Age 21 and under = $25

You can pay online at: http://tbwcsa.com/about-us/membership/

or pay with cash or check at the dance. Checks should be made payable to "Tampa Bay West Coast Swing Assoc."