Swingin' Singles Membership Application
Print CLEARLY the completed application and return application and fees at a dance
or mail to:  Donna Pearson, 5803 Manor Drive, Parkville,MO 64152-6061
Phone: 816-216-7684   Cell: 785-691-5249

Name:         Birth Date  MM-DD    
Address:

City:    St:  Zip+4:
Phone:

Cell:              Todays
Date:   
e-mail:

                    If you have internet access, do you want the newsletter emailed to you?

           Check where applicable:
       New Applicant Renewal Annual Renewals are due September 1
 X
Annual Membership Dues $ 5.00  
Insurance (see note below) $ 4.75  
Swingin' Singles Name Badge (with standard Fastner) $ 7.50 
Swingin' Singles Name Badge (with magnetic fastener) $10.00  
Do you want the newsletter mailed to you? $10.00  
Fed Facts Subscription - (6 issues annually)
$21.00  

    (Fed Facts pro-rated after December - $3.50 per issue
           will be subtracted from total if New Applicant is checked)
Kansas TRAVEL-ON Magazine (3 issues per year) $17.00  
Missouri Doinís Magazine (6 issues annually)
$15.00  
Click for Total Amount Due (Make checks payable to Swingin' Singles)






If your insurance is paid though another club, please indicate the name of the club

                                          :   

Would you serve on a committee?      Would you serve as an officer?

For New Members:  Sponsor:

Board Member:                      

Note: It is required that all members of Swingin' Singles have USDA Insurance.  To remain eligible for USDA's Liability insurance, Swingin' Singles must have 100% of its members insured through our club or another club with Liability insurance.

The Swingin' Singles reserves the right to refuse membership to anyone whose presence of conduct is deemed by the Board not to be in the best interests of the Club or Square Dancing fellowship. (Bylaws Article III, Section 4 & 5)

Please note: There will be a $20 Charge for Returned Checks.                                                               03/20/2017