Syracuse Social Club Membership Form

You may use this application to join the Syracuse Social Club just by clicking on the submit button on the bottom of this page. We suggest that you call the club owners at 315-652-7145 and give them your credit card information. You may also choose to print this page and mail this form and credit card information to the club PO BOX. Membership has advantages over non members, the best advantage is that members pay $10.00 less admission to each dance. The member appreciation dance members get in free each year and house parties only members can attend. Another member advantage is members get a free e mail account. Membership costs $50.00 Per Year.

Personal Information

His Name Lifestyleprofiles ID

Her Name Swinglifestyle ID

Last Name Lovevoodoo ID

Address Swappernet ID

City Yahoo ID

State E mail address #1

Zip E mail address #2

County Would you like information sent to you via e mail yes No

Her Driver license # State Her Date of Birth

His Driver license # State His Date of Birth

Attendance is to certify that you are 21 years of age or older and hold the same philosophy as stated in Syracuse Social Clubs Rules and Regulations and you will observe 11 government rules and regulations. You also declare, that you are seeking this meeting of your own free will as a private person.

We certify that we are not employed or associated professionally with anyone, whereby we are seeking to obtain material and! or information to be used in a profession. (example: TV, Radio, Newspapers, Magazines, etc.) and we also certify that we are not a member of or associated with any government or law enforcement agency, here to entrap or obtain information to be used as part of any investigation and, we are adults who wishes to participate in adult activities. We understand that there are risks in everything we do, and also acknowledge that we are making our own decisions to participate in the parties organized by Syracuse Social Club. In keeping with the philosophy of Syracuse Social Club, it is our sole decision to participate or not and, by signing this application, we agree to release Syracuse Social Club from any and all claims based on anything occurring at or as a result of any parties or other functions in which we may participate. On behalf of ourselves and anyone related to me, we release Syracuse Social Club and any persons acting on its behalf from any and all claims based on any personal injury of any kind and any property damage of any kind resulting in any way from our participation in parties or activities related to Syracuse Social Club, and by signing below, we certify that the above statements are true. We also agree to abide by the rules and regulations set by Syracuse Social Club. (see SSC rules web page)

His Signature:_____________________________________Date:_____________

Her Signature:_____________________________________Date:_____________

By Clicking on the Submit button you agree to the statement listed directly above.