Heart of America Singles Square Dance Association
INDIVIDUAL APPLICATION
Use this form by printing it and filling it out, OR
by downloading the source file, editing to fill it out, and printing.
Print Name__________________________________________________________________
Address_____________________________________________________________________
City________________________________________State________Zip_________________
Phone______________________________________Birth Date_______________________
Home Club__________________________________Town___________________________
Individual Membership $4.00 (2 yrs. $8.00, etc.)
_______________
HASSDA Badge (with City/State bar) $6.50
_______________
Fun Badge (1" × 1" HASSDA logo) $1.00
_______________
Total amount enclosed (payable to HASSDA)
_______________
I want my listing in HASSDA Directory to include my:
Name: Yes / No Address: Yes / No Phone: Yes / No
I would consider helping on the HASSDA board:
Officer Area Coordinator Special Projects
Make check payable to:
HASSDA
Mail application & check to:
HASSDA
PO Box 214
Mission, KS 66201
Members will receive a roster and a quarterly newsletter that will include details about singles activities and square dance festivals.
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