SANDPIPERS SQUARE DANCE CLUB
Membership Application

Click below for printable Adobe Acrobat form (updated May 2014).
Membership Application Form

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