Membership Application

All information collected in this form will be on file for the reference of CPJSA Council or a designated Event Coordinator. It will not be shared outside of the club, and will be stored in a secure Google Drive.

Type of Application *

• New Member Application
• Member Information Update

Name *

First

Last

Phone Number *

Mobile number that will be carried during events and practices preferred

Address *

Please include number, street, town, state, and zip

Email *

Birth Date *

Emergency Contact *

First

Last

Emergency Contact Phone Number *

Notes

Additional information that may be helpful for the club to know (severe allergies, physical limitations, etc.)

Acknowledgement of Risk *

• I acknowledge that lightsaber choreography can be dangerous and involves a risk of injury. By participating, I am accepting that this risk is my responsibility.

Acknowledgement of Media Use *

• I acknowledge that CPJSA will be recording video, audio, and taking pictures during practices and events. These media may be used on the club website, social media, press kit, and other promotional materials both printed and electronic. It is my responsibility to ask if I do not want something recorded or posted.

Submit