BALLROOM DANCE CLUB MEMBERSHIP REGISTRATION
(PLEASE PRINT CLEARLY)
(Membership is from September – August) Please
return by September 1, 2011.
NAME: ___________________________________________
STREET: ___________________________________________
CITY: ___________________________ STATE: _________________ ZIP CODE: ______________
PHONE: ____________________ EMAIL: _________________________________________________
DUES ENCLOSED: ____ $75 per single membership ____ $150 per couple membership
Prorated Fees: ___Jan $120/60 ___Feb $110/55 ___Mar $100/50 ___April $90/45 May $70/35
Membership cards will not be issued for the 2010-2011 year. Name is on membership list at the door.
RETURN TO: Joanie Keuser 2425 S Main Ave. Sioux Falls, SD 57105