Membership Registration
Form
TRIANGLE COUNTRY
DANCERS
Please check one: c New Member c Renewal c Change/Correction
Please check the type of
membership: c $10 16-25 years old
c $20 26-64 years old
c $10 65+ years old
Today’s Date:
_____/_____/_____ Amount Paid $ ____________
Name:
___________________________________________________
Street Address:
___________________________________________
City:
Phone:
(h)______________________ (w) _______________________
Email: ___________________________________________________
Please Check, Circle, or Complete Applicable
Statements
c Please DO NOT include my name
in the TCD phone book or Hey!
c Please DO NOT include my phone
number in the TCD phone book or
Hey!
c Please DO NOT include my email
address in the TCD phone book or
Hey!
c Please include my name in the Happy Birthday section of the Hey!
Month ____ Day ____
c I share a household with another TCD member, and we would
like to receive only one newsletter.
The other member’s
name is: _____________________________________________________
c I do not wish to become a member, but I would like to be on
the mailing list of Spring Dance Romance and
other special mailings.
c I would like to volunteer my time (at least occasionally). I
am most interested in:
c Cleaning up after dances
c Hosting out-of-town bands/callers
c Helping with decorations for special dances
c Helping to provide snacks during the break
c Working on a special project (e.g. benefits, Spring Dance
Romance)
c Being a coordinator (e.g. dance night, publicity, sound,
membership, booking, house manager, newsletter, volunteers, webmaster)
c Serving on the board
Other
________________________________________________________________________
The best time to call is:
__________________
Please Print Legibly!