FORCES OF THE EMPIRE, INC.

MEMBERSHIP APPLICATION

(2014)

 

Please Print legibly.  Send this application and your dues (no cash, please)

Lisa J. Schmidt, 324 Adams Court, Ferndale, MI 48220

 

Name:

Birthday:

Email:

 

Instant Messenger Name(s):

 

Official Use Only:

Date received __________

Acknowledgment

Mailed _______________

Address:

Ph # (       )

City, State, Zip (or Country Address)

 

Amount Enclosed

Renewal?

Yes _________

No  _________

Membership Type

Regular:                   __________

Spouse/Roommate: __________

Check # ______________

 

Money Order# _________

Have you ever been convicted of a violent or child-related offense in any state or jurisdiction?

Yes ________ No ________ Explain:

 

Membership dues for Force of the Empire are payable annually on the anniversary date of joining the organization

 

REGULAR MEMBERSHIP:                           $5.00 US per year

 

Regular members receive access to the Members-Only Web Site, have full voting rights, receive a two-dollar ($2.00) discount on the Blaster Battle Role Play participation fee, held at MediaWestCon*, and access to the FOE email lists.

 

All applicants, whether new or renewing, must read and sign the following waiver.  If the member is under eighteen (18) years of age, the parent or legal guardian must sign on behalf of the minor applicant.

 

Forces of the Empire and Universes Interactive Literature Association, Inc., reserves the right to refuse membership or renewal of any person who has previously received a grievance or has otherwise demonstrated an unwillingness to follow the rules and bylaws of the organization.

 

                I UNDERSTAND THE FORCES OF THE EMPIRE ORGANIZES AND HOSTS LIVE ACTION ROLE PLAY ACTIVITIES.  I AGREE THAT I DO NOT AND WILL NOT HOLD FORCES OF THE EMPIRE OR ALTERNATE UNIVERSES INTERACTIVE LITERATURE ASSOCIATION, INC., THEIR TRUSTEES, OFFICERS, OR MEMBERS LIABLE FOR ANY INJURY I MAY INCUR WHILE PARTICIPATING IN SAID EVENTS.  BY SIGNING BELOW, I BIND MYSELF TO THIS AGREEMENT

 

Signature:                                                                                                                            Date                                                                    

 

PLEASE LIST YOUR CHARACTERS AND DIVISIONS BELOW/ use extra paper if necessary

Name                                                                                                                                                                 Division