GREENVILLE RENEGAYDES L.L.C, PO Box 9226, Greenville, SC  29604-9226
								
PERSONAL INFORMATION

NAME ____________________________________________  DATE OF BIRTH _____________													
ADDRESS _________________________CITY____________________STATE ___ZIP ________
							 			
TELEPHONE (_____)_____-_________ EMAIL______________________@________________						
MEMBERSHIP REQUESTED: FULL _____________  ASSOCIATE ___________________	

CLUB RELATED TALENTS_________________________________________________________		
[] Bartending [] Cooking [] Accounting [] Artist [] Sound/DJ []Photography 
[] Writing    [] Speaking[] Leatherwork / Craft _____  Other ________________

CLUB ASSOCIATIONS____________________________________________________________	

GENERAL INFORMATION
Hobbies and Interests:________________________________________________________							
Reason(s) for Joining:________________________________________________________
In the event of a medical emergency do you have any physical or medical		
conditions that the club or its members should be aware of? 			
________________________________________________________________________________									
Emergency contact person(s)________________________ Phone #_____________________									
DUES INFORMATION									
Application Fee: $20.00 is refundable should you not become a full member. 									
Full Membership Applicants: The Applicant will spend three (3) months in an 
acquaintance / Pledge period so that he or she can get to know the club members and
its purpose. Once your membership has been approved, yearly dues are incurred and 
payable each August at the club meeting. Full members in good standing have voting 
privileges and may hold office. 									

Associate Membership Applicants: Lifetime Associate membership dues of $35.00 are 
incurred and payable upon approval of your application. Associates in good standing 
maintain the right to wear an associate's patch, but do not have the right to vote 
or hold office. DUES ARE SUBJECT TO CHANGE WITHOUT NOTICE									

DISCLAIMER									
Membership is open to all persons regardless of race, color, creed, gender, sexual 
orientation, or who is at least 21 years of age. By signing this application, I 
certify that I am at least 21 years of age and that the information supplied is true 
and accurate. I will not hold The Renegaydes L/LC, its members of associates liable 
for anything incidental or consequential and will abide by all club by-laws and 
rules of conduct. Failure to comply will be terms for removal from the club. 

Signed:_________________________________________ Dated: _______________________									
CLUB USE ONLY
MEMBER SPONSORS (2 FULL MEMBERS REQUIRED)

1.)_____________________________________2.)____________________________________					
RECEIVED:_________ APPROVED:_________ DISAPPROVED: __________ DATE:____________