Click here for a printable version of this form to mail in.   

MEMBERSHIP BENEFITS
Twice yearly Newsletter, Club Parties, Club Travel, 10% Off All Dance Store merchandise

Discounted Admission to
Monthly Club Dances, Guest Instructor Workshops,
Mad About Dance Academy Classes, and Local Night Clubs

Pro Rated Annual Membership Dues - May 2007 thru April 30, 2008
Check one and circle your appropriate enrollment start date. All memberships renew May 1, 2008

Individual
May 07 - April 08 $35
Sept. 07 - April 08 $30
Jan. 08 - April 08 $20

Married Couple
May 07 - April 08 $45
Sept.07 - April 08 $40
Jan.08 - April 08 $30

Student (age 12-21)
May 07 - April 08 $20
Nov. 07 - April 08 $15

PLEASE PRINT

Member Name:
Mailing Address:
City: State Zip:
Email Address
Phone: (H) (W)
Occupation Birthday

Spouse Name
Email Address
Phone: (H) (W)
Occupation Birthday:



I am interested in the following styles of dance and recreational activities:
West Coast Swing East Coast Swing Hustle Latin
Carolina Shag Ballroom Other


Backpacking Horseback Riding Canoeing Ice Skating Rafting Sailing
Day Hikes Camping Snow Skiing Other


Are you interested in coordinating club activities or have a special skill that would be of assistance to your club? If so, you will be contacted by a Committee member to discuss the requirements and club events/activities needing your support. Thanks!
Yes, I am interested.

I fully realize that Carolina Dance Club activities involve a risk of personal injury and property damage, and I hereby agree to assume all risk of any injury, damage or loss of my person or property. I hereby for myself, my heirs, executors and administrators, waive and release any claims or rights against the Carolina Dance Club and all officers, directors and coordinators for any and all injury, damage or loss to my person or property incurred during these activities. I agree to abide by the By laws and Policies of the Carolina Dance Club.MEMBERSHIPS ARE NON-TRANSFERABLE.

Signatures:

Member: X ___________________________________ Date: ______ / ______

Spouse: X ___________________________________ Date: ______ / ______

If you want to pay for your membership by credit card, please fill out the information to the right. Name on Card:
Card Type:  VISA      Mastercard      Discover    
Card Number:
Expiration Date: /

Please make your check payable to:
 CAROLINA DANCE CLUB

Further questions please call
1-888-21-SWING
Fax (919) 494-2373

Mail this form with your check to:
Membership Director
Carolina Dance Club
P.O. Box 58492
Raleigh, NC 27658

CLUB USE ONLY
 Qbks
Dbase
Check# _______________
Member# ______________
Date Issued __________






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