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MEMBERSHIP APPLICATION

2006

RENEWALS  - $20.00

NEW MEMBERS  - $25.00

NAME: _________________________________________________________________

STR. ADDRESS:__________________________________________________________

CITY______________________________________STATE _______ZIP_____________

PHONE: (H)___________________(W):___________________  (C):________________

BIRTHDAY :(M)________(D)________
 
EMAIL  ADDR:__________________________________________________

PROFESSION:___________________________________________________       

The Charleston  Shag Club encourages all members to support the club by  serving on committees carrying out "fun work".  Please indicate your choice of  committee participation. Membership (  )    Dance (  )   Food (   )   Social (   )   Newsletter (   )Publicity (   )   Ways & Means (   )   Geechee Blast (   )   Telephone (   )    Audio/Video Equip (   )   

Date:_______________ Member Signature_____________________________

New members only sign here_________________________________________
CSC new member sponsor sign here___________________________________

  • Make checks in the amount of $20.00 (Renewals) or $25.00 (New Members)

  • Payable to: CHARLESTON SHAG CLUB

  • Mail to:
  • Charleston Shag Club, 603 Wading Court, Mt. Pleasant, S.C. 29464

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