Wufoo

Tallahassee 25 Application

Membership Application Information:

To ensure the integrity of the Tallahassee 25 and to provide a safe environment, only members in good standing are able to participate in events that involve children. A member in good standing must:

•Pay his/her annual contribution (dues)

•Agree to and clear a background check according to the requirements provided in the Tallahassee 25 bylaws

•Agree to adhere to the Tallahassee bylaws (available online or by request)

•Agree to adhere to the following policies:

*Please indicate that you understand and agree by checking each box of the following statements stating that I:
*
will NOT initiate any activities with children and represent myself as a member of the Tallahassee 25 if the event is not sponsored/endorsed by T25. will NOT be under the influence of, or use alcohol, tobacco, or any controlled substance at any Tallahassee 25 volunteer event. acknowledge that my membership may be terminated at the discretion of the Executive Board. understand T25 will NOT indemnify, reimburse or defend me, for any legal action taken against me for my actions that violate T25 Terms of Agreement.*
* - Membership Agreement, the Tallahassee 25 Bylaws, or the Tallahassee 25 Membership Code of Ethics (available online or by request) or any of the following:

•I misrepresent Tallahassee 25 in any way

•I act in a negligent manner (and/or put a child/member at risk)

Personal Information:

**By completing and signing below, I, in good faith, attest that I:

1.Allow the Tallahassee 25 to conduct a background check on me.

2.Agree to adhere to all of the terms and agreements of membership stated on this application, in the bylaws, and in the Membership Code of Ethics.

3.Will not participate in events involving children until I am notified of my background check being cleared and my membership being confirmed.

4. That you understand and agree by checking the four statements listed on this form.

5. That you have paid your member dues either in person or through our Paypal online account via the T25 wesbite.

Application Fees are $25.00 per applicant. Checks may be made payable to Tallahassee 25. Contributions are tax deductible as Tallahassee 25 is a
501(c)(3 ) organization. A canceled copy of your check will act as a receipt.
Full Name * First Last
Home or Mobile Phone * ### - ### - ####
Home Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Personal Email *
Date of Birth *
(Enter SS# and Race) *
Drivers License # and State Issued *
Do Not Fill This Out