| VIRGINIA SQUARE AND ROUND DANCE ASSOCIATION MEMBERSHIP APPLICATION RENEWING DUES __________ NEW MEMBER__________ LAST NAME____________________________________________________________________ HIS NAME___________________ HER NAME_________________ ADDERSS_______________________________________________________________________ CITY______________________ STATE__________________ ZIP_____________ TELEPHONE NUMBER__________________________________________________________ E-MAIL ADDRESS________________________________________________________________ CLUB AFFILIATION ______________________________________________________________ ARE YOU A CALLER_______ CUER_______LINE DANCEINSTRUCTOR_________________ CONTRA PROMPTER_____________ WOULD YOU BE WILLING TO SERVE AS A DIRECTOR FOR YOUR REGION ? YES__________ NO________ OR THE VIRGINIA STATE CONVENTION? YES ________ NO ______ ANNUAL DUES $8.00 PER COUPLE FOR ONE YEAR OR DISCOUNT: PAY FOR TWO YEARS ---- $14.00 PER COUPLE MAKE CHECKS PAYABLE TO VASARDA MAIL TO JIM & JOYCE HALFHILL 1537 GALVANI DR. VA.BEACH, VA. 23454 PHONE 757-426-6195 *********************************************************************************** VASARDA BADGE ORDER FORM (YOU MOST BE A VASARDA MEMBER) LAST NAME_____________________________________________________________________ HIS NAME______________________ HER NAME ___________________ ADDERSS________________________________________________________________________ CITY _________________________ STATE ___________ ZIP ________________ COST $10.00 PER BADGE NUMBER ORDERED____________ TOTAL ENCLOSED$_____________ REVISED MAY 2009 JH |