Capital City Shag Club P.O. Box 3429 Columbia, SC 29230   Organized 2008 2010 Membership Application January 1 –December 31, 2010 Membership Dues: $45.00 per person            Please make checks payable to: Capital City Shag Club Name: Address: City/State/Zip: Phone: Home: Work: Cell:  Email: Birthday: Month: Day:  Year: Occupation: Notice: Membership in the Capital City Shag Club shall be extended to persons who are at least 21 years of age, dedicated to the preservation of The Shag and the music associated with it, and who conduct themselves with appropriate social demeanor. All memberships are subject to the approval of the Executive Board. Release: For and in consideration of dues paid for membership in the Capital City Shag Club (CCSC), I, the undersigned, being of lawful age, hereby release and forever discharge the CCSC from any and all causes of action, claims, and demands for,  upon, or by reason of any damage, loss, or injury, which heretofore has been sustained by me as a consequence of my actions at any CCSC function. It is understood that the act of admission to CCSC sponsored events as a member is not construed asan admission on the part of CCSC of any liability to me whatsoever for any personal injury or loss. Please make checks payable to: Capital City Shag Club Payment: Cash: $ Check:# Amount: $ Applicant Signature:_________________________________________ Date: Sponsor or Club Officer Signature___________________________________ Date: Please volunteer for a party or standing committee