Club Membership Application

Heart of America Singles Square Dance Association

CLUB APPLICATION


Use this form by printing it and filling it out, OR
by downloading the source file, editing to fill it out, and printing.


Print Club Name______________________________________________________________

Dance Address_______________________________________________________________

City_________________________________________State________Zip________________

Contact Person_______________________________________________________________

Home Address_______________________________________________________________

City_________________________________________State________Zip________________

Home Phone__________________________________Other__________________________

Club Caller____________________________

Club Cuer___________________________

Home Address_________________________

Home Address________________________

City__________________________________

City________________________________

State_________________________________

State________________________________

Zip___________________________________

Zip__________________________________

Phone________________________________ Phone________________________________

Dance Level: (Circle All Applicable)

We dance:�������� Mainstream�������� Plus�������� Advanced�������� Rounds�������� Lines

Dance Nights & Times:________________________________________________________

Dance Location:______________________________________________________________


Club Membership / year
$10 �������� Less than 50 members����� $_____________
$15 �������� 51 to 100 members $_____________
$25 �������� 101 or more members $_____________


Please advise Newsletter Editor of any special dances your club will be sponsoring. Newsletter deadlines are 2/15 for March, 5/15 for June, 8/15 for Sept., 11/15 for December. Clubs will receive a quarterly newsletter that will include details about singles activities & square dance festivals.

Make check payable to: ���������� HASSDA
Mail application & check to: ���������� HASSDA
PO Box 214
Mission, KS 66201


back to HASSDA home page ����� to individual application


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