BESS Contributorship Application/Renewal Form
BESS Contributorship Application/Renewal Form
This is a (circle one): New Application Renewal
For Renewals, please enter your contributor number (if you know it). For New Applications, a Contributor Number will be assigned.
Contributor Number |
Date
Name
Scene Name
E-mail Address
May we contact you via email (circle one)? Yes No
Would you be interested in volunteering (circle one)? Yes No
**For demographic information only (optional)
State
Zip
How did you hear about BESS?
Special instructions to the Database Manager
By completing and signing this application, I agree to the following: I am at least 19 years of age. By my signature, I hereby assume all risks incidental to my attendance at BESS events. I agree to abide by the Safe Space Policy, and all BESS Bylaws, Policies and Procedures, and to obey all published Event Rules. I agree to hold harmless BESS, Inc., its Board of Directors and Officers, and their agents, assigns and successors, and the owners, managers, employees and agents of any facility in which BESS hosts an event for any injury to person or property which may occur incident to my attendance at a BESS event. I agree to limit disclosure of Confidential Information within BESS to its directors, officers and contributors having a need to know and shall not disclose Confidential Information (including but not limited to contact and other identifying information of other Contributors) to any third party without prior written consent of the BESS Board of Directors. I swear/affirm that I am not a registered sex offender in any jurisdiction. Any falsification of this form or of the signatures will result in termination of contributorship. Contributorships are not transferable or refundable.
Signature
BESS Representative checking Identification: ID Type: