Swingin' Singles Membership Application
Annual Renewals are due September 1
  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    

City:    St:  Zip+4:

Cell:              Todays

                                        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
Annual Membership Dues $ 5.00  
Insurance (see note below) $ 4.75  
Swingin' Singles Name Badge (with standard Fastner)
 Color of Badge: Blue Singles Badge   White Married Badge
$ 7.50 
Swingin' Singles Name Badge (with magnetic fastener)
Color of Badge: Blue Singles Badge   White Married Badge
Do you want the newsletter mailed to you? $10.00  
Fed Facts Subscription - (6 issues annually)

    (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) $20.00  
Missouri Doinís Magazine (6 issues annually)
Click for Total Amount Due (Make checks payable to Swingin' Singles)

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

If your insurance is paid though another club, please indicate the name of the club:                                                                                                           
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.                                  07/16/2018