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G.S.C.A. MEMBERSHIP FORM

JOIN THE FUN…..

BECOME A MEMBER OF THE

GOPHER STATE CLOGGING ASSOCIATION

                            Membership means….

                                       * Quarterly Newsletter with information on upcoming events
                                       * Reduced fees for Association activities
                                       * Workshops
                                       * CD of music from Fall Workshop
                                       * Directory of Members & Instructors
                                       * Your link to Local and National Clogging Information

It also means…… * Fun * Fellowship * New Friends

ANNUAL DUES: $15.00 PER PERSON 12 AND UP
$25.00 PER FAMILY (living at same address)
$ 5.00 PER CHILD 11 AND UNDER (Individuals not part of family membership)

Detach and mail to:       Gopher State Clogging Association
                                                c/o Phil Pederson
                                                13339 6th St. N, Stillwater, MN 55082

Fee must accompany form Make checks payable to: G.S.C.A.
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Please fill in your information, Print and mail form w/payment to address above.

GSCA MEMBERSHIP FORM

MAY 1, 2007 TO APRIL 30, 2008

NAME:Member under 12: Yes No

Address:City:

State: Zip:

Phone(Home): (Work):

E-mail:

Dancer Director Instructor Performer

Club/Group

Please check if you Do Not want your name in the G.S.C.A. Directory

Received by_______________________Date:_________________________$__________________

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For more information please contact:
G.S.C.A. member Pam Portz
email: smashingtoe@yahoo.com