Membership Form

Royal Scottish Country Dance Society

Central Iowa Branch

Name_______________________________________________________________________

Address____________________________________________________________________

       ____________________________________________________________________

Home Phone_______________________   Work Phone_____________________________

e-mail_____________________________________________________________________


What is your interest in Scottish Country dancing?_________________________

___________________________________________________________________________

Would you be willing to have your name, address, phone number, and

e-mail address in a branch membership directory?___________________________

Would you be willing to help with one or more of the following?

Publicity______  Socials_____  Class Organization______  Board Member______ 

Book Library_____  Music Library_____  Equip. Maintenance_____ Other_______

Fees: Single: $30.00______ Couple: $50.00______  

Payable annually.  Fiscal year is from July 1.


Please send check and form to:  
Gayle Hoepner,  413 tenth St.,   Ames, IA 50010