2006

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