SANDPIPERS SQUARE DANCE CLUB
Membership Application
Click below for printable Adobe Acrobat form (updated May 2014).
Date:__________________________________________
Last name _____________________________________
His First name __________________________________
Her First name __________________________________
Phone Number __________________________________
E-mail address__________________________________
Mail Address:
City___________________________________________
State__________________________________________
Zip Code_______________________________________
His Birthday____________________________________
Her Birthday___________________________________
Anniversary___________________________________
Membership in the Sandpipers Square Dance Club is hereby requested. If accepted, I / we agree to abide by the club rules and support the club activities. We agree to pay a one time initiation fee plus club dues semi-annually in advance. Payment of dues entitles me / us to attend all regular club dances for that half-year. Dues are payable at the time of initiation and then on June 1st and December 1st.
FEES AND DUES:
One-time initiation fee: $15 each.
Semi-annual dues: $30 for individuals and $60 for couples. (The dues are pro-rated @ $5 / month if you join in the middle of a half-year term. I / we understand the initiation fee covers the cost of insurance and imprinted badge.
Fee type
|
Rate
|
Multiply by # of applicants
|
Total fee
|
Initiation fees
|
$15
|
X ( )
|
$
|
Semi-annual dues
|
$30
|
X ( )
|
$
|
|
|
Total enclosed:
|
$
|
Dues for graduates of Sandpipers classes will start the first of the month following graduation. All other applicants will pay the prorated monthly dues for the half-year of their acceptance. Acceptance as a member is not complete until dues are paid and Board approval is received. I / we understand that special dances may not be included in the dues.
His Signature__________________________
Her Signature _________________________
********** MEMORANDUM OF BOARD ACTION *********
[____] Board Approved
[____] Board Denied, Initiation Fee Returned
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