Prairie Squares

MEMBERSHIP APPLICATION
Last Revised  01/07/07
 
 
Date: _______________________
 
 
Name (Mr, Mrs, Ms): ____________________________________
 
 
Spouse: ______________________________________________
 
 
Address: _____________________________________ Apt. # _______
 
 
City:__________________ State: ________ Zip:________
 
 
Phone: Day:  ( ____ ) ___________ Night: ( ____ ) _________
    
 
E-Mail: _____________________________________
 

Note: All dance notices are sent by E-Mail
 
 
MAIL TO:   PRAIRIE SQUARES
    1390 SOUTHFORK TRAIL
    REDDING, CA 96003
 

INCLUDE CHECK MADE OUT TO: PRAIRIE SQUARES FOR $15.00/PERSON
PLEASE MAKE SURE THAT I WILL BE ABLE TO READ WHAT YOU WRITE!
 
 
 

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