世紀藝術聯合基金會
Century Arts Alliance Foundation
2146 Ringwood Ave. San Jose, CA 95131 Tel: 408-571-CAAF (2223) Fax: 408-571-2228 www.centuryarts.org
以下會員資料請詳細用正楷填寫, 謝謝您的合作 !
Please use one form per person. Clearly and completely print the following membership information.
Thank you for your cooperation.
會員資料/ Member information

英文姓名 First name: _____________ Last name: _______________
中文姓名 Chinese name:______________________
生日Date of birth: 年 Year:___ 月Month: ___日Day:___
地址 Address:______________________________________________
城市 City: ____________州 State:______郵遞區號 Zip code: _________
住家電話 Home Tel: ______________________手機 Cell:_____________
公司電話 Office Tel :______________________傳真 Fax: ________________
電郵信箱 E-mail: _______________________________________________
性別 Sex: 男 M ____ 女 F____ 駕照號碼 Driver License:__________________
Member number

 

for CAAF use only

緊急聯絡人資料/ Emergency contact persons information

1.中文姓名:________________英文姓名 Name: ___________________________
住家電話 Tel: __________公司電話 Office Tel: __________手機 Cell:________
2.中文姓名:________________英文姓名 Name:___________________________
住家電話 Tel: __________公司電話 Office Tel: __________手機 Cell:_________
會費及付款方式/ Admission fee and payment information

會員月費 $20.00 元. 65歲以上& 12 歲 以下為 $10元, 半年為一期.
一次支付$1,200.00 元將使您成為本會永久會員,同時您也將被邀請成為本會永久榮譽董事.
Admission fee for membership is $20 per month for six months. Fee for members who is older than 65 or younger than 12 is $10 per month for six months. Fee for permanent members of this foundation is one payment of $1,200.00, you will also be invited to become a life time honor directors of this foundation.
卡號Visa Card No: ________________有效期Exp date: _________________
卡號 Master Card No: _____________有效期Exp date:_________________
信用卡付款金額 Credit card amount:__________________________________
支票號碼Check no: _____支票金額Check amount: _____現金金額Cash amount:________
支票抬頭請寫 CAAF. / Make check payable to CAAF.

* 請同時具結同意書以完成入會申請 . * Please also sign the agreement page to complete the application for CAAF member.

 

 

Century Arts Alliance Foundation
Hold Harmless and Indemnification Agreement


I / We, _________________________________,hereby understand and agree to accept the risk of my /our participation in any and all activities for which specific space has been reserved for specific times. This shall include, but not be limited to, assignment of time and space regularly scheduled activities, sporadic use and one time events. With this understanding, I / We further agree to indemnify, defend and hold harmless the Century Arts Alliance Foundation its president and boar of directors, agents and employees from and against any all claims, losses, injuries, suits or judgments arising from, or in connection with my / our successors, assign, heirs, executors and administration, and any other person or entities who / which may have a claim based on my / our personal injuries and / or property damage. I / We further understand and agree that this hold harmless and indemnification shall apply to any and all facilities of the Century Arts Alliance Foundation Should any dispute arise which we are unable to resolve through negotiation or the use of third party mediation, the undersigned agree to submit to resolution by arbitration in accordance with the rules of the American Arbitration Association. IN AGREEING TO ARBITRATION, WE BOTH ACKNOWLEDGE THAT IN THE EVENT OF A DISPUTE OVER FEES, EACH OF US IS GIVING UP THE RIGHT TO HAVE THE DISPUTE DECIDED IN A COURT OF LAW BEFORE ANY JUDGE OR JURY AND INSTEAD ARE ACCEPTATIONS THE USE OF ARBITRATION FOR RESOLUTION. The prevailing party shall be entitled to the allowance of a reasonable attorney’s fee and other costs of such action.

1. Century Arts Alliance Foundation reserves the right to cancel your membership if you interfere with the interests of this organization.
2. Please take good care of your personal belongings, because Century Arts Alliance Foundation is not responsible for the loss of personal belongings of its members and their guests.
3.This membership is non-transferable, and it has to be renewed every six months.
4. There will be a $ 5 charge for the reissuing of lost membership card, and there will also be a change of $15 for bounced check.
5. CAAF is a registered non-profit organization under IRS Code section 501(c) (3), donations are tax deductible to he extent allowed by law. Tax ID # 20-1648825



Applicant's signature:

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