Membership Form (for new members or new information)

Royal Scottish Country Dance Society

Central Iowa Branch

Name(s)______________________________________________________________________

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: $40.00 ______  Couple: $70.00 ______  

Payable annually.  Fiscal year is from July 1.

Please send this form and check, payable to "RSCDS - Central Iowa Branch", to
  
David Michael,  612 Carroll Ave,  Ames, IA 50010