2012 Application for Membership in the Mayfair Dance Club

 

Complete and email to: Thomas Pollock tp1836@prodigy.net Or Print and mail to address below: Mayfair Dance Club c/o Thomas Pollock 38 Autumn Oaks Drive The Hills, TX 78738-1409 We want to join! Please accept our application for membership in the Mayfair Dance Club Mayfair Dance Club was recommended to us by: _____________________________ We understand that our membership acceptance is limited by the following club Bylaws. · Recommendation of an existing member couple. · Limited Membership of 100 couples. · Full payment of $225 Member Dues for the year 2012 submitted with the Member application. Submission of Member Biographical Data. _____________________________ Signature of Member Applicant Date: _______________________ Questions? Please call: 512-261-9922 Personal Data for Member's Pictorial Directory Please Type or Print in Ink Name(s): ____________________________________ Address: ____________________________________ City: ___________________ State: __ Zip: _________ Home Phone: __________________________ Fax: _________________________________ Cell: _________________________________ Email: ________________________________ Birthday-His: *______ Birthday-Hers: *______ Anniversary: *______ (*Month and Day Only) Biographical Sketch (Please type or print 100 words maximum) Please complete and return this data sheet with photograph for the 2012 Directory which prints in March, 2012