2003
Membership Renewal Card #_______
Annual Membership Donation $20.00 Dependent under age 16 yrs. $5.00
Please fill in all information, and do NOT use the word Same in place of information.
Membership expires at the end of the calendar year.
circle one Name____________________________________ Male / Female
(Leader / Follower)
Address______________________________________________
City_________________ State____________ Zip_____________
Home Phone_________________ Alternate Phone____________
E-Mail Address________________________________
No Unless you circle No here, your e-mail address will be published in the club directory (club use only).
No Unless you circle No here, you will receive an electronic notice to read the newsletter.
Supplying your e-mail address means you
will be automatically enrolled for an electronic notice to view the newsletter
on the club's web site (www.tsdc.net).
A paper newsletter will not be mailed to your address, unless it is requested.
Birthday _______________ Occupation________________________
(Month & Day only)
How did you first hear about Tucson Swing Dance Club?
_____________________________________________________
Release:I agree to hold the Tucson Swing Dance Club (TSDC) harmless from
all suits, claims or damage of any kind arising from this activity. I also agree to
abide with the By-laws of the TSDC.
Signature _____________________________________
Mail to: P.O. Box 32226, Tucson, AZ 85751-2226
Include a self addressed stamped envelope to have your card mailed to you.
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(Do not write below this line)
Date paid / received _____________ Expiration date _Dec. 2003__
Check €
or M.O. €
Received by: ____________________
