Wisconsin Dance Council Membership Form

To join the Wisconsin Dance Council, print this form, complete it and mail with payment to:

Wisconsin Dance Council
Post Office Box 707
Madison, WI 53713-0707

Please print all information.


CONTACT INFORMATION:

NAME_________________________________________________________

ADDRESS_____________________________________________________

CITY__________________________________________________________

STATE________________________ ZIP CODE________________________

TELEPHONE NUMBER ___________________________________________

WEBSITE______________________________________________________

EMAIL_________________________________________________________


MEMBERSHIP TYPE: (Check one)

NEW_______          RENEWAL ________ (#YEARS _______ )

TYPE OF MEMBERSHIP: (Check one)

REGULAR ($25)_______

STUDENT ($10)_______

RETIREE ($10)_______

PROFESSIONAL ORGANIZATION ($30)_______

STUDENT ORGANIZATION ($12)_______