GRUPO CULTURAL LATINOS EN ROCHESTER NY, INC.

VIVA LA CULTURA LATINA!

www.gcler.org
Mission: To promote Latin American cultural heritage in Western NY, through educational/ informative events and entertaining life
performances

Membership Form 2016

Family Name -or- Organization:

Date:

Address:
City/State/Country/Zip
Telephone: (C) (H):

E-Mail Address:

MEMBERSHIP LEVEL:
$ 45 Basic Member
$ 60 joint (two at the same address)
$ 20 Full-time student
$ 60 Organizations and institutions
Make a donation and help support the organization that support Latin-America folklore!
$ 60 Supporting Member
$ 100-$499 Latinos en Rochester Circle
$ 500 and up Viva la Cultura Latina! Club
Please make check payable to: Grupo Cultural Latinos En Rochester NY, Inc. Mail membership form: 641 Kayloc Circle, Webster
NY 14580 or pdf e-mail at: info@gcler.org
I could volunteer to assist in: the following activities (optional)
Dances
Committees
Publicity
Craft and Sewing
Other:
For registrant who are minor, please fill out the following information:
Name:_______________________________________
Date of birth:_______ Grade:_______
Parents name:_______________ Mothers or fathers cell phone:__________________
For scheduling purposes, what is the earliest time of day that you can practice?
Weekdays________________________ Weekends_______________________
We do our best in scheduling to consider everyones schedule, however it is it is impossible to completely accommodate everyone.
By joining Grupo Cultural Latinos En Rochester Team, you and your child are making a commitment to attend ALL scheduled
rehearsals, classes, showcase, and to pay ALL related fees. By signing below, you are committing yourself and your participation as
well as being financially responsible for the appropriate fees. MEMBERSHIP FEES ARE NONREFUNDABLE AND ARE STILL
DUE PAYABLE IN FULL EVEN IF YOU DROP OUT OR DO NOT HONOR YOUR RESPONSIBILITY TO ATTEND ALL
CLASSES, REHEARSALS, AND EVENTS. Participation and placement in the different dances is at the full discretion of the
directors and is based on skill level and other criteria. Dance member may be expected not to participate in the performances if they
have not been consistent in attending classes, rehearsals. By signing below, you are agreeing to the above terms.
Signature (by parent or guardian if minor): I hereby indemnify Grupo Cultural Latinos En Rochester NY, Inc. From any and all
liabilities that may occur due to the conduct of the classes, activities and performance at our members house or any other location .

***Sign_____________________________ Date:_________________________________________