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Dayton Squash Center Membership Agreement
2006 – 2007 Season

NAME: (print) Last:___________________First:_____________MI:_____Birthdate:_________

SPOUSE'S NAME: (print) ___________________________Birthdate:_________

HOME ADDRESS: (print)______________________________________________

CITY: (print)__________________STATE:_________ZIP CODE:____________

HOME PHONE: (print)___________________WORK PHONE:________________FAX:________________

EMAIL ADDRESS: (print)___________________USSRA# (if applicable)____________

OTHER CLUB AFFILIATIONS:__________________________________________________

CHILDRENS NAMES AND BIRTHDATES: (ages 21 and under)

NAME:__________BIRTHDATE:_______NAME:__________BIRTHDATE:________

NAME:__________BIRTHDATE:_______NAME:__________BIRTHDATE:________

NAME:__________BIRTHDATE:_______NAME:__________BIRTHDATE:________

NAME:__________BIRTHDATE:_______NAME:__________BIRTHDATE:________

MEMBERSHIP FEES:

Monthly Option______ $49.95* per month
( 12 payments billed to your Visa, Mastercard, or American express Card )
* State Sales Tax of 7% as Mandated by Ohio Law on all club memberships will be added

Card Type (Visa, MC, AmX) ______ Card # _______________________Exp. Date _______

I authorize the Dayton Squash Center Pro Shop (cjsquash.com) to charge my card # above 12 monthly payments of $49.95 plus tax in return for my annual membership in the DSC. I understand that my membership is for one full year (beginning the first membership month)) and that I am responsible for all 12 payments, regardless of use. If membership is terminated prior to 12 months of use,, I agree that my credit card shall be charged the remaining balance.

Signed:_________________________ Date:______________

Annual Option: $595. 00* paid by check ( 12 month membership from date of receipt)
*includes State Sales Tax as Mandated by Ohio Law on all club memberships ($556.10 annual dues plus $38.90 sales tax)

Please mail completed and signed membership agreement (with check if Annual Option selected) to:
DAYTON SQUASH CENTER, 3200 West Tech Road, Miamisburg, OH 45342.

Dayton Squash Racquets Association (DSRA) Membership: The DSRA offers Dayton Squash Center members a discounted membership fee of $65 (normal cost $80), which includes participation in the DSRA League, USSRA national membership, 1 year subscription to Squash Magazine, discounted entry to Ohio Open, Dayton City & Baby Boomers tournaments and social events like cookouts & pizza parties with free clinics from Charlie Johnson & Rob McFadzean

_____ YES! Sign me up for the DSRA. _____ Additional Check for $65 to DSRA Enclosed _____ Charge my CC# above.

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.

SIGNATURE:__________________________________________ DATE:________________

ACCEPTED BY:________________________________________ DATE:________________