2011 RENEWALS - $25.00 / NEW MEMBERS - $30.00 NAME: STREET ADDRESS: CITY: STATE: ZIP: PHONE: (H): (W): (C): BIRTHDAY: (M)  (D) EMAIL: PROFESSION/OCCUPATION: NEW MEMBER ONLY - NAME ON BADGE: 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 Food Newsletter Dance Social Geechee Blast Date:____________ Member Signature ________________________________ CSC Sponsor's Signature:______________________________________________ Check amount: $25.00 (Renewals) or $30.00 (New Members) Check Payable to: CHARLESTON SHAG CLUB Mail check to: Charleston Shag Club, 2167 Ft. Pemberton Dr., Charleston, SC 29412