ATLANTA SWING DANCERS CLUB, Inc.

2007 MEMBERSHIP APPLICATION

PLEASE PRINT CLEARLY!

Annual Dues: $35 (through 12/31/07)    Renewal____New Member____

Membership No._______

RCVD BY__________ CHECK#_______CASH________DATE______________

NAME: __________________________________________ BIRTH MONTH _______DAY______

ADDRESS: ____________________________________________________________________

CITY: __________________________ STATE: ___________ ZIPCODE: _________________

HOME PHONE: ____________________

WORK PHONE* ____________________       * ONLY ENTER IF YOU CAN BE CALLED AT WORK

E-MAIL ADDRESS: ____________________________________________________________

How did you learn of the club? ___________________________________________________

Occupation/Hobbies_____________________________________________________________

Please circle any of the following you would like included in the Club Directory:

(Note: If you publish no information, you will not receive a copy of the directory)

1)  Name        2)  eMail Address      3)  Phone numbers                4)  mailing address

I would be interested in working on the following committee(s): (CIRCLE PRIMARY CHOICE)

Membership          Telephone              Social               Publicity           Newsletter                    Anything

In consideration of the mutual benefits derived from membership in the Atlanta Swing Dancers Club, Inc., acknowledging that an injury may occur while dancing.  The undersigned does hereby assume all risks and absolves releases and waives any and all liability claims or demands against the Atlanta Swing Dancers Club, Inc., its officers, directors, and each and every member thereof, which may arise out of an act related to an injury.

Signature ___________________________________ Date_______________________________

This membership expires December 31, 2007.

Note:  Make checks payable to: Atlanta Swing Dancers Club or ASDC

Mail to:                            PO Box 28058, Atlanta, GA 30358