Membership Form
New Renewal Address Change

 

Name:		Date:
Street Address:
City:		State:		Zip:
Home Phone:		Cell Phone:
Work Phone:		Email Address:
Birthday (Month/Day)		If under 21, Year of Birth
Sign here to approve pictures of yourself in newsletter:		_______________________________
Annual dues are $20 per person. Please return this form and check or money order payable to CowTown Swing Dance Club, to: CowTown Swing Dance Club, PO Box 9097, Shawnee Mission, KS., 66201