Savoy Swing Club Membership Form

Refer to the table for membership types and costs. To become a member, sign up online or
send this form with a check to: Savoy Swing Club, P.O. Box 12114, Seattle, WA 98102.

Name:
Address:
City/State/Zip:
Phone:		Email:
Member Type (circle):	Regular - Student - Family		Birthday:*
* Optional; but if you don't tell us, we won't know when to surprise you with a birthday dance at a club function!
If you are joining as a student, enclose your Student ID Number or a copy of your Student ID!

Total amount due: $______________.

Savoy Swing Club publishes a list of phone number for the exclusive use of our members. You have the option to have your phone number kept out of the publication.

___ It's OK to include my phone number.

___ It's OK to include other contact information such as email address.

Would you like to receive postal mail about upcoming events? ___ Yes ___ No

Savoy Swing Club relies on its members to operate - we are an all-volunteer organization. Volunteering is a great way to meet your fellow club members and make your mark on the club.

___ I would be willing to help out at club events.

In signing below, I agree to dance in a safe and responsible manner so that I do not endanger myself or others. I also agree not to hold the Savoy Swing Club or its instructors responsible for any injuries or damages sustained by me during class, practice sessions, dances, workshops or performances.

Signed _________________________________________________ Date __________________

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