MAFIA Member Monthly Party Application Form
Mid America Fists In Action, Inc.
P.O. Box 25107 Chicago, IL 60625-0107
Phone: 312.401.8893
Email address *
What is your year of Birth? *
Your answer
Party Date *
Party date: Saturday, May 5, 2018
Phone Number *
Your answer
First Name *
Your answer
Last Name *
Your answer
Address *
Street address including unit number
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Country *
Your answer
Voluntary Participation, Execution of Knowledge, Indemnity, Assumption of Risk, and Hold Harmless *
I am freely and voluntarily choosing to attend and participate in this event and to view and/or participate in activities that I know are adult oriented Sexual Fetishes. I understand that these activities involve certain risks including, but not limited to, the possible negligent or reckless conduct of other participants. I have carefully read this document. I fully understand the contents. I am aware that by signing this document I release liability and bind a contract between M.A.F.I.A. and myself. I am giving up my legal rights and remedies and as good and valuable consideration for admission to this event. I agree to indemnify and hold harmless Mid America Fists In Action Inc., and those individuals and entities described in this document, from any loss, liability, injury, damage or cost that they may occur or that they may incur due to my presence or my actions at the event, whether caused by my negligence or otherwise. I am aware that these activities can be extremely hazardous. I voluntarily am participating in these activities with full understanding of the hazards involved.
Release of Legal Claims or Charges and Agreement of Rules and Regulations *
As consideration for being permitted by Mid America Fists In Action Inc. to enter the event, and to view and participate in these activities, and to use the facilities and equipment being provided. I agree to the following. I, myself, a person on behalf of me or through me will make any claim against or sue the following:*Mid America Fists In Action Inc.* Affiliates of Mid America Fists In Action Inc.(including, but not limited to, the officers, directors, members, agents, employees, volunteers, promoters, sponsors, contractors, the property owners, lessors or suppliers of the premises, lessors or suppliers of any equipment used in connection with the event) for the following:Any injury or damage suffered by me at any time during my presence at the event or because of my participation in any activities at the event.I hereby release, waive and forever discharge them, their heirs, administrators, executors, and assigns, from any and all claims, demand, actions or rights of action, of what ever kind or nature, either in law or in equity, arising from or by reason of my attendance at or participation in the event or activities.
Punch-A-Bunch credits
I am attending using one of my Punch-A-Bunch credits:
Party Credit
I am attending using one of my party credits. Party credits may be given for volunteer activities. Party credits expire after 90 days
Electronic Signature for this form *
I have agreed to submit this Dungeon Party Registration by electronic means
NEXT CLICK SUBMIT at the bottom of this form to Complete Your Payment
Your answer
A copy of your responses will be emailed to the address you provided.
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