Youngstown Exiles Inc.

Founding Membership Application

Home Bar : Mineshaft 1105 Poland Ave. Youngstown, OH 44502

email: website:

PLEASE PRINT CLEARLY • I Am Applying For ___FULL ($15)

NAME: (Last / First / Middle) ________________________________________________________________________ ADDRESS: _____________________________________________________________________________ CITY: ____________________________________________________ STATE: ______ ZIP:__________________ HOME PHONE: ( _____ ) ______________________

eMAIL: _________________________________________

_____________________________________________________________________________Are u over 21 years old: _______ (You Must Be At Least 21 Years Old)

Interests: _______________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Leather Affiliations: _______________________________________________________________ __________________________________________________________________________________________________________________________________________________________ Why do you want to join? __________________________________________________________ __________________________________________________________________________________________________________________________________________________________

Exiles Membership Agreement & Waiver I hereby make application to be considered for full membership in the Exiles, Inc. of Youngstown, Ohio, :

I agree to comply with the By Laws and Code Of Regulations as currently established and as may be amended, revised, repealed, or established by a vote of the membership in the future in accordance with the established procedures of the organization;

I agree to hold blameless the Exiles, Inc., its members, officers, trustees and all property owners for any actions while investigating, discussing or voting on my application and for damage or injury to myself, others, or my personal property at any organization event. Attached is my application fee as evidence of my good faith in the written or implied purposes of this organization. By my signature below, I agree to all of the above and certify that I am at least of the age of 21 years old at the time of signing.

Applicant’s Signature: _____________________________________________ Date: _________