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New Member
Returning Member
California State University of Fullerton
Circle K International
Membership Application 2015- 2016
Traveler’s Information
Name:
Birthday:
Current address:
City:
Shirt Size: S M L XL
XL
Emergency Information
Email:
Phone:
Zip Code:
CWID:
Year in School:
Major:
Name:
Phone:
Alt. Phone:
Relationship:
Membership Dues
Annual membership dues are $50 and are good until September 30th, 2016. Please make all checks payable
to Circle K International.
Please choose which option you prefer. Just t-shirts alone will cost $15.
$50: Membership + TShirt
$40: Membership
$30: Payment Plan
$30: Payment Plan + TShirt
Membership Benefits
What do you get with your paid membership?
 A year full of service, fellowship, and leadership with new friends and memories!
 Receive coverage from the Kiwanis International Comprehensive General Liability Insurance.
 Access to ‘Members Only’ events such as Fall Training Conference, Snow-Cial, & District Convention!!
 Be a part of our Membership Recognition Program; get recognized for your hard work! You also get the
opportunity to become Member of the Week or even Member of the Month!
 Receive emails and updates about club events; you will also be added to our private Facebook Group
for CSU Fullerton Circle K Members.
 Many leadership opportunities, scholarship opportunities, and so much more
For Treasurer’s Use
Collected by _______________________ on _____/______/______
$_________ in cash or check #_____________
Receipt #________________
Notes
Please fill out all 4 pages of this application clearly and turn it in at the next general body meeting.
Questions? Email CSUF.CircleK.Treasurer@gmail.com
Applications must be printed, stapled, and turned in with your dues!
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New Member
Returning Member
CSU Fullerton Circle K International
Waiver of Liability, Assumption of Risk, and Indemnity Agreement
Waiver: In consideration of being permitted to participate in any way in any activities related to Circle K
International hereinafter called "The Activity", I, for myself, my heirs, personal representatives or assigns, do
hereby release, waive, discharge, and covenant not to sue The Regents of the California State University and
Kiwanis International, its officers, employees, and agents from liability from any and all claims resulting in
personal injury, accidents or illnesses (including death), and property loss arising from, but not limited to,
participation in Activity.
Assumption of Risks: Participation in Activity carries with it certain inherent risks that cannot be eliminated
regardless of the care taken to avoid injuries. The specific risks vary from one activity to another, but the risks
range from 1) minor injuries such as scratches, bruises, and sprains to 2) major injuries such as eye injury or
loss of sight, joint or back injuries, heart attacks, and concussions to 3) catastrophic injuries including paralysis
and death.
I have read the previous paragraphs and I know, understand, and appreciate these and
other risks that are inherent in Activity. I hereby assert that my participation is voluntary
and that I knowingly assume all such risks.
Indemnification and Hold Harmless: I also agree to INDEMNIFY AND HOLD The Regents of the California
State University and Kiwanis International HARMLESS from any and all claims, actions, suits, procedures, costs,
expenses, damages and liabilities, including attorney’s fees brought as a result of my involvement in Activity and
to reimburse them for any such expenses incurred. If I need medical treatment, I agree to be financially
responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry
my own health insurance.
Severability: The undersigned further expressly agrees that the foregoing waiver and assumption of risks
agreement is intended to be as broad and inclusive as is permitted by the law of the State of California and that if
any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force
and effect.
Acknowledgment of Understanding: I have read this waiver of liability, assumption of risk, and indemnity
agreement, fully understand its terms, and understand that I am giving up substantial rights, including my right to
sue. I acknowledge that I am signing the agreement freely and voluntarily, and intend by my signature to be
a complete and unconditional release of all liability to the greatest extent allowed by law.
Printed Name of Participant
Date
Signature of Participant
Photography and Recordings Waiver and Release Form
I,
, hereby authorize Circle K International at CSU Fullerton and its legal
representatives the irrevocable right and unrestricted permission to use and publish photographs or videos of
me, or in which I may be included, for any purpose authorized by Circle K International, without limitation, to
reproduce, copy, sell, exhibit, publish, or distribute, in any medium now known or later developed, including but
not limited to: pictures, website use, editorial publications, catalog and advertising use. This grant includes the
right to modify and retouch the images in the discretion of Circle K International at CSU Fullerton. I understand
that the circulation of such materials could be worldwide and that there will be no compensation to me for this
use. Furthermore, I understand that I will not be given the opportunity to inspect or approve the finished products
or the advertising copy or the printed matter that may be used in connection therewith. In granting this
permission to Circle K International at CSU Fullerton and its legal representatives, I am fully and without
limitation releasing it from any liability that may arise from the use of the images, recordings, or videos, including
but not limited to any and all claims for invasion of privacy, defamation, or infringement of copyright.
I have read and understood the provisions of this agreement and I acknowledge that I have freely and voluntarily
entered into this agreement.
Printed Name of Participant
Date
Signature of Participant
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New Member
Returning Member
Cal-Nev-Ha District of Circle K International
CSUF Circle K Code of Conduct
April 1st, 2015- March 30th, 2016
Instructions: This form must be completed and turned in by all prospective and returning CSUF Circle K
members.
The Board of Officers of California State University, Fullerton Circle K International hopes that every member,
prospective or returning, will enjoy the 2015-2016 year of CSUF Circle K. The following Code of Conduct has been
established to make this term as safe and enjoyable for all attendees and will be in effect during the entire 20152016 term.
1.
No drugs of any nature, with the exception of prescribed medication, will be permitted in the possession of
anyone in attendance of any Circle K event.
2.
The prohibition of the consumption of alcohol will be enforced at all times during any Circle K event.
3.
Care shall be taken not to deface or destroy any property at any Circle K event. The individual(s)
responsible will pay for any damages.
4.
All Circle K members are expected to conduct themselves as responsible, professional men and women
while attending any Circle K event.
5.
Attendees will be expected to dress appropriately depending on the event.
6.
Infractions of the Code of Conduct will be reported to the District Board of Officers and the District
Administrator. Appropriate action will be taken for any infraction, including the dismissal of any attendee
from the event at the expense of the individual.
7.
The Code of Conduct is in effect from the moment an attendee becomes a dues paid member of Circle K
International.
I agree to abide by the CSUF Circle K Code of Conduct. I will respect the authority of the 2015- 2016 CSUF Board
of Officers and understand that infractions of the Code will be reported to the District Board of Officers and the
District Administrator. I understand appropriate corrective action will be taken for any infractions including (but not
limited to) suspension of membership, inability to attend District event, and removal from Circle K International.
____
Signature
Print Name
Date
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New Member
Returning Member
CSUF Circle K International Questionnaire:
Nick Name:
For your birthday, can we send you a birthday shoutout during the meeting, on Facebook, or on our club
website?
yes
no
Do you have any allergies or dietary/medical needs that we should know about?
Would you like to be added to the following emailing lists?
California-Nevada-Hawaii District Member Bi-Monthly Emailing List
Magic Kingdom Division Google Emailing List
CSUF Circle K Google Emailing List
Kiwanis History (e.g. Key Club, KIWIN’s, K-Kids, Builder’s Club):
Which School?
Where did you grow up?
Where would you like to travel? Dream Destination?
We’re so close to Disneyland. Do you have a pass?
yes
no
What type?
What’s your favorite animal? Color? Disney Character?
What do you do for recreation? Games, Sports, Read, Hobbies…etc.
Favorite Movie Genre?
All-time favorite Movie? TV Show?
Favorite Music Genre?
Bands/artists?
We are a service club. What types of service do you enjoy doing? Food banks, renovations, landscaping, clean
ups, helping children, cooking/serving food, packaging food/ toys, etc.
What is air?
Which emoji is the best (or you like the most)? Draw it out here 
Tell us something random/crazy about yourself!
Would you want to participate in our Big/Little (Mentor/Mentee) program?
yes
no