New Members - Full Year (April 1 through March 31 of the following year) ____ Single Person -$16.00 initiation/membership fee         (includes $1 one-time initiation fee for new single members) ____ Couple (Same Address) -$27.00 initiation/membership fee        (includes $2 one-time initiation fee for new couple members) New Members - Half Year (After Oct 1) ____ Single Person -$8.50 initiation/membership fee         (includes $1 one-time initiation fee for new single members) ____ Couple (Same Address) -$14.50 initiation/membership fee         (includes $2 one-time initiation fee for new couple members) Renewals (Full Year) ____ Single Person - $15.00 ____ Couple (Same Address) - $25.00 PLEASE PRINT Date: ______________ Name: ________________________________________________________________________ Address: ________________________________________________________________________ City, State, Zip: ________________________________________________________________________ Home Phone: ________________________________________________________________________ Work Phone: ________________________________________________________________________ Email Address: ________________________________________________________________________ ____ YES ____ NO I am/We are over 21 years of age ____ YES ____ NO Include my/our name, address, phone number and email address in the club directory I would prefer my newsletter to be sent: ____ Traditional U.S. Mail ____ Electronically

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Make your check or Money Order payable to:
Minnesota West Coast Swing Dance Club, Inc.
PO Box 2343, St. Paul, MN 55102-0343