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STEEL SACNTUARY MEMBERSHIP APPLICATION
PLEASE PRINT
CLEARLY AND COMPLETE ONE SECTION PER INDIVIDUAL–EACH PERSON MUST SIGN. | Membership Type: (check one) | | Single Membership $25.00 | | | Individual 1: (Complete for Single) | | | Scene Name:(on your card) | _________________________________________ | Optional Information: | | | Legal Name: | _________________________________________ | Gender: | Male | Female | Transgender | | | Email Address: | _________________________________________ | Orientation: | Het | Gay | Lesbian | Bi | | | Mailing Address | _________________________________________ | Age: | 18-30 | 31-50 | 51-65 | 66+ | | | | _________________________________________ | | | | | City/State/Zip: | _________________________________________ | | | | | | _________________________________________ | | | | | | | Office
Use OnlyMember No Issued: State Photo ID Checked _______ | | | By completing and signing this form
I am agreeing to the following: · I am at least 18 years of age. · I am not acting in the capacity of or in association with any
law enforcement, media or religious organization. · By my signature here, I hereby assume all risks incidental to my attendance at Steel
Sanctuary events. · I agree to abide by all Steel Sanctuary Policies and Procedures and to obey all published Event Rules.
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I swear/affirm that I am not a registered
sex offender in any jurisdiction. · Any falsification of this form or of the signatures will result in termination of
membership. Memberships are not transferable or refundable.·
I agree to hold harmless Steel Sanctuary,
its Board of Directors and Officers, and their agents, assigns and successors, and the owners, managers, employees and agents
of any facility in which Steel Sanctuary hosts an event for any injury to person or property which may occur incident to my
attendance at a Steel Sanctuary event. | | | Signature:(Required) | X | Date: | | | | | | | | | | | | | | | | | | | | | | | |
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