Dayton Squash Center Membership Application
2006 – 2007 SEASON

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CLICK HERE FOR PRINTABLE MEMBERSHIP AGREEMENT

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Please Fill In The Information Below:

USE PRINTABLE MEMBERSHIP FORM IF PAYING BY CREDIT CARD

* Required Fields

*Name       
Birth Date
Spouse's Name
Spouse's Birthdate
*Address   
*City           
*State         
*Zip Code  
*Home Phone 
Work Phone 
Fax
Pager 
USSRA #
(if Applicable)

Other Club Affiliation(s)

Childrens Names and Birthdates (ages 21 and under)
Name Birthdate
Name Birthdate
Name Birthdate
Name Birthdate

Type of Membership Desired:
12 Month $595.00 (Annual membership starting month check received)
(Make check payable to the Dayton Squash Center, mail to: 3200 West Tech Rd. Miamisburg, OH 45342)

Monthly Payment Billed To Credit Card (Annual membership in 12 monthly installments)
(Please use printable membership form)

We often use the internet to communicate with our members.
The information below is so we may all have a direct line of communication to you.
It is not given out, your privacy is respected.

Do You Own A Computer ? YES NO
*Email 
AOL Instant Messenger 
ICQ Number 

Optional Information:
Age  Male Female
Married Single    Children... Yes No
Occupation 

Best Time For Us To Contact You 

Any questions or comments ?

Liability/Waiver of Claims: Each member hereby expressly agrees that all use of the Dayton Squash Center's (DSC) facilities shall be undertaken at the member's sole risk, and DSC shall not be liable for injuries or damages to members or guests, including, without limitation, those injuries or damages resulting from acts of active or passive negligence on the part of DSC, its owners, officers and assignees, or agents. Each member, for himself/herself and family members, and on behalf of his/her executors, administrators and assignees, expressly releases and forever discharges and indemnifies the DSC, its successors and assignees, as well as its owners, officers and employees and agents, from all such claims, injuries, damages, actions or causes of action. Further, it is agreed that DSC is not responsible or liable to members or their guests, for articles or possessions lost, stolen or damaged including their automobiles and contents thereof.