The Lake Murray Beach Blast

The Lake Murray Beach Music Society

The Cotton House

7777 St. Andrews Rd.

Irmo, SC 29036

I, ______________________ am a member of the Lake Murray Beach Music Society.

(print name)

By my signature and witness below, I assume total responsibility for my actions to and from and during any functions I attend held by a group of friends assuming the name “The Lake Murray Beach Music Society”, which holds no assets.

Furthermore, if my actions cause any medical, physical, or mental hardships, I hold myself solely responsible and will not attempt any restitution from any of the friends or organizers of the event I attend.

I hold harmless and blameless both the Cotton House and the Lake Murray Beach Music Society from any and all liabilities related to me attending the aforementioned functions.

Signed:_____________________________ Date:________________

Witness:____________________________ Date:_________________

PERSONAL INFORMATION:

Name: ________________________________________

Address: ________________________________________

City: _____________________ St:_____ Zip:_______

Phone: __________________ Cell: ________________

Email: _________________________________________ *

*Note: The Society will use email and a website to communicate with it’s members.

This information will be held in strict confidence.

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