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2008-2009 Membership Application (Please Print)

Applicant's Name  ______________________________________

Street Address _________________________________________ City _________________________________________________

State _____________________________ Zip Code____________

Phone ____________________________ E-Mail Address _________________________________________

(The Club would like to send out the Newsletters by e-mail whenever possible to help hold down costs and membership dues.)

           I, the undersigned, in support of my application, make the following statements:

 I agree to abide by the By-Laws of the club and other such rules and regulations as may be adopted by the club from time to time.

           I agree to participate in the activities of the club as I may be requested by any office of the club or committee.

Respectfully submitted,

Applicants signature: ___________________________________________________________________

Note:  Membership dues for September 2008 through August 2009 are only $125.  Since regular admission is $20 per couple per dance your membership gives you almost six free dances compared to purchasing admission at the door.  More significantly, it helps provide a stable base for the continuation of the Couples Dance Club so we can continue to offer big band dancing opportunities in Sioux Falls.

Make your check payable to the Couples Dance Club and mail your application and dues to:

Gene Engebretson, 3435 W. 84th Place, Sioux Falls, SD 57108

Phone:  605-334-3554

FOR CLUB USE ONLY:

Date of Receipt ____________________________________

Date Card Issued ___________________________________

Number on Card ___________________________________

Updated:  11/17/2009