DELAWARE VALLEY SWING CLUB
        902 Mansion Ave - Westmont, NJ - 08108 - www.delvalshag.org


DUES:  $20 per person per year                                      Membership Renewal Due on Anniversary Date
Date:   Birthday:   (ONLY Month and Day Please)

Name:

Address: 

City:        State:       Zip Code:.          

Home Phone:

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Would you like to volunteer to help with a Club Committee or activity?  If so just check what is of interest to you.   


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How did you hear about our club?  


Club funds are used for social events, club activigties, club publications and club communications. Officers and committee members ALL work as VOLUNTEERS and are not compensated for their tiem. By signing this form and accepting membership into the Delaware Valley Swing Club (DVSC), I agree to allow my name, address, phone number and birthday to be published in a roster availalbe to club members, unless I specificially state otherwise to the club. In signing this form, I agree to abide by the rules of the club and to relinquish the club of any responsibility or liability for injury to me resulting from my participation in the activities of the club, and to allow for the use of photograhps in DelVal Swing Club publications. Print out and mail completed application to: Del Val Swing Club, c/o Sheila Purkey, President, 902 Mansion Ave, Westmont, NJ 08108.  Make check or money order payable to"DVSC". 
NOTE:  There is a $25.00 fee for any returned check.
Signature:Date:
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