For Club Use Only 
    Member # ______________
    Date __________________
    Ck. #__________________
    Amount________________    		 Mail with $20 check (no cash) to:
    KC Swing Dance Club
     6101 Martway
    Mission, KS 66202
    OR  bring  to  the club  house.

    K a n s a s  C i t y  S w i n g  D a n c e  C l u  b
    M e m b e r s h i p    A p p l i c a t i o n

    _______________________________________________________________________
    Name
    _______________________________________________________________________
    Address                                                                  City                           State   Zip
    ____________________________________   __________________________________
    (Area Code)  & Phone                                        (Area Code)  & Business Phone
    ____________________________________   __________________________________
    Email                                                                   Birth Date (year optional)
    Date Joined _________________________
    How did you learn about the club:
  • o Seeing club members dance at________________________________ 
  • oA friend
  • o News or  other  Article 
  • oClub Card 
  • oWeb Site 
  • oOther_______________

    • The club is comprised of volunteers.  A small contribution of each member’s own special talent
    will make this a better club.  Please indicate any area you may be able to help your club with:
  • o Sign-in 
  • o Newsletter mailings 
  • o Phone Calling
  • o Club House Cleaning 
  • o D. J. Friday night dances 
  • o Other________________________

    • I support the K.C. Swing Dance Club’s goal of advancing swing dancing and do hereby apply
    for membership.  I agree to abide by the rules and bylaws of the K. C. Swing Dance Club while participating in the club activities or representing the club, and agree that the club shall not be 
    responsible for any injury or loss.

    ____________________________________________         ________________________
    Signature (required)                                                                                   Date