Membership Application from Class Member(s)

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" height=35 style=" border-bottom: 1px solid #000000;" BGCOLOR="#CC99CC" TEXT="#080000" background="0d526611ezuady.png"> <div> <FONT SIZE="5" COLOR="#FFFFFF" FACE="Times New Roman" ><B>Sandpipers Square Dance Club</B></FONT><B>  </B><B> </B><B>|   </B><A HREF="index.htm" TARGET="_top" TITLE="Sandpipers Square Dance Club"><B>home</B></A></div> <div>                                                   </div> <div> </div> </td> </tr><tr> <td valign="top" height=445 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <B>SANDPIPERS</B><B> </B><B>SQUARE DANCE CLUB</B></div> <div> <B>Membership Application</B></div> <bR> <div> <B>Date:</B><B>__________________________________________</B></div> <div> <B>Last name  </B><B>_____________________________________</B></div> <div> <B>His First name</B><B> __________________________________</B></div> <div> <B>Her First name __________________________________</B></div> <div> <B>Phone Number __________________________________</B></div> <div> <B>E-mail address__________________________________</B></div> <div> <B>Mail Address:</B></div> <div> <B>City___________________________________________</B></div> <div> <B>State__________________________________________</B></div> <div> <B>Zip____________________________________________</B><B>                                                                                                      </B></div> <div> <B>His Birthday____________________________________ </B></div> <div> <B>Her Birthday___________________________________</B></div> <div> <B>Anniversary___________________________________ </B></div> <bR> <div> 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 <I>plus</I> club dues quarterly, in advance.  Payment of dues entitles me / us to attend all regular club dances for that quarter.  Dues are payable at the time of initiation and then on the first of the months of January, April, July and October.  </div> <bR> <div> FEES:</div> <div> One-time initiation fee:  $15.00</div> <div> Quarterly dues:  $15.00 for individuals and $30.00 for couples.  (This fee is pro-rated @ $5 / month if you join in the middle of a quarter.  Any excess will be applied to your next quarterly dues.)</div> <bR> <bR> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="601" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 23 WIDTH="141"><div> <B>Fee type</B></div> </tD> <tD VALIGN=TOP WIDTH="88"><div> <B>Rate</B></div> </tD> <tD VALIGN=TOP><NOBR><div> <B>Multiply by # of applicants</B></div> </NOBR></tD> <tD VALIGN=TOP><NOBR><div> <B>Total fee</B></div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 23 ><NOBR><div> Initiation fees</div> </NOBR></tD> <tD VALIGN=TOP WIDTH="88"><div> $15.00</div> </tD> <tD VALIGN=TOP WIDTH="247"><div> X  (            )</div> </tD> <tD VALIGN=TOP WIDTH="100"><div> $</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 23 ><NOBR><div> Quarterly dues</div> </NOBR></tD> <tD VALIGN=TOP WIDTH="88"><div> $15.00</div> </tD> <tD VALIGN=TOP WIDTH="247"><div> X  (            )</div> </tD> <tD VALIGN=TOP WIDTH="100"><div> $</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 23 WIDTH="141"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="141" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="88"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="88" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="247"><div> <B>Total enclosed:</B></div> </tD> <tD VALIGN=TOP WIDTH="100"><div> $</div> </tD> </tR> </TABLE></div> <bR> <bR> <div> I / We understand the initiation fee is to cover the cost of insurance, visitation badges, etc.  Dues for the Graduates of the Sandpipers classes will start the first of the month following graduation.  All other applicants will promptly pay the prorated per monthly dues for the quarter of their acceptance.  Acceptance as a member is not complete until dues are paid.  I / we understand that special dances are not included in the dues.</div> <bR> <div> <B>His Signature</B><B>__________________________</B></div> <div> <B>Her Signature</B><B> _________________________</B></div> <bR> <div> <B>              ********** </B><B>MEMORANDUM OF BOARD </B><B>ACTION *********</B></div> <bR> <div> <B>Date:__________________</B></div> <div> <B>[____] Board Approved</B></div> <div> <B>[____] Board Denied, Initiation Fee Returned</B></div> <div> <B>For the Board of Directors:___________________________</B></div> <bR> </td> </tr></table></body>