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Please complete this form and submit with your $15.00 membership fee to: Mississippi Mudds Membership, P.O. Box 224, Carleton Place, On K7C 3P3 Part A - Membership You must be 18 years of age or over to become a member. A member concurs with the purpose of The Mudds, will be bound by the Mudds Constitution, and will behave in a manner that will not bring The Mudds into disrepute or censure. NAME ______________________________________________________________ PHONE __________________________________ POSTAL ADDRESS ____________________________________________________ EMAIL ADDRESS ______________________________________________________ BIRTHDATE _______________________________________________________ |
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*This info is needed for the accident insurance which covers all Mudds members. PRIVACY CONSENT FORM In conjunction with the Privacy Policy of the Mississippi Mudds of Carleton Place *, As a member of the Mississippi Mudds, I hereby agree to the following: 1. As a member of the cast or crew of any Mudds production, my name and photograph may be published in newspapers and/or on the Mudds web site 2. I will not use or disclose personal information such as names, addresses (including e-mail), telephone numbers of any Mudds members to any third party for any reason Member:_____________________________________________________________ Consent Signature:____________________________________________________ Does Not Consent:_____________________________________________________ Date:________________________________________________________________ * The privacy Policy can be viewed by going to www.mississippimudds.ca and following the links through the Noticeboard to "Documents". |