Your Email Address:
Date:
New member
Renewal
Dance
preference: Couples
Line Both
Last Name
First Spouse, if joining
Address
City State Zip code +4
Phone --
Birthday (month/day)Spouse's BD, if joining
(month/day)
Wedding Anniversary
(month/day)
Will
you help with a club activity?
If
yes, check your interestSetup/cleanup
at events Newsletter help
Host an
event Help at an event
or other (list)
Will you teach for lesson nights? Yes
No
How/ through whom did you learn of our organization?
New members, per person:
If joining before the 25th of the month use the pro-rated dues as listed,
otherwise use the next month's dues: June-$18.00; July-$16.50;
August-$15.00; September-$13.50; October-$12.00; November-$10.50;
December-$9.00; January-$7.50; February-$6.00; March-$4.50; April-$3.00;
May-$1.50.
Renewals, per person; Do Not pro-rate;
$18.00, even if you're late!!
Complete this form and turn in payment at the first
event you attend, or
Make Check payable to MVCDA
and mail to:
MVCDA Treasurer,