MEMBERSHIP APPLICATION

NORTH HOUSTON SWING DANCE CLUB

5306 Wild Blackberry Drive

Kingwood, Texas  77345-2022

281-350-6941

 

DATE:____/____/____                                                                                               ___ $45/6mos.               ___ $60/yr.

 

CHECK ONE: ____ NEW MEMBER  ____ PREVIOUS MEMBER    ____ 6 MOS RENEWAL   ____ 1 YR RENEWAL  ____ PRORATED RENEWAL

 

NAME:___________________________________  SPOUSE:____________________  BIRTHDAY _____/______

                                                                                                                                                                   (mo / day)

ADDRESS:_______________________________________________________________________

 

CITY:________________________       STATE:___________          ZIP:____________-__________

 

HOME PHONE:(____)_____-________  WORK PHONE: (____)_____-________  CELL:(____)_____-________

 

EMAIL: __|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

 

How did you find us? (Name of:person, organization, ad, website, etc.)_____________________________________________

|_____|  Initial in box at left to authorize release of home phone number and address in club directory.

Make my day, let me help with:      ____ Registration              ____ Advertising               ____ Fliers/Calendars ____ Just Call me, I’ll help             ____ Newsletter                 ____ Decorating                ____ Event Planning  

 

FOR CLUB USE ONLY

    Amount Received $_____________                                                   _____ Cash     Check #_______________

    Received By: __________________                                                                        Receipt # _______________                                                                   

                                                                                             

MEMBERSHIP APPLICATION

NORTH HOUSTON SWING DANCE CLUB

5306 Wild Blackberry Drive

Kingwood, Texas  77345-2022

281-350-6941

 

DATE:____/____/____                                                                                               ___ $45/6mos.               ___ $60/yr.

 

CHECK ONE: ____ NEW MEMBER  ____ PREVIOUS MEMBER    ____ 6 MOS RENEWAL   ____ 1 YR RENEWAL  ____ PRORATED RENEWAL

 

NAME:___________________________________  SPOUSE:____________________  BIRTHDAY _____/______

                                                                                                                                                                   (mo / day)

ADDRESS:_______________________________________________________________________

 

CITY:________________________       STATE:___________          ZIP:____________-__________

 

HOME PHONE:(____)_____-________  WORK PHONE: (____)_____-________  CELL:(____)_____-________

 

EMAIL: __|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

 

How did you find us? (Name of:person, organization, ad, website, etc.)_____________________________________________

|_____|  Initial in box at left to authorize release of home phone number and address in club directory.

Make my day, let me help with:      ____ Registration              ____ Advertising               ____ Fliers/Calendars ____ Just Call me, I’ll help             ____ Newsletter                 ____ Decorating                ____ Event Planning  

 

FOR CLUB USE ONLY

    Amount Received $_____________                                                   _____ Cash     Check #_______________

    Received By: __________________                                                                        Receipt # _______________

                                                                                                                                                                          Rev. 01/05/04

 

 

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