Membership Application

Name:

Address:

City:

State:

Zip:

Phone:

School:

Email:

To be on our mailing list: Yes No

By signing this application, I am agreeing to abide by two rules: I will not participate in any drug or alcohol while at this club and I will respect the property and those around me. If I violate these rules, my application will be revoked and I will no longer be able to attend events at the Living Room.

Sign:

Print this form, fill it out, and bring it with you when you come.