BAKERSFIELD CHAPTER



                                    APPLICATION FOR MEMBERSHIP

                               ($85.00 MEMBERSHIP FEE MUST ACCOMPANY APPLICATION)


Date: __________________________    Name: _________________________________

Date of Birth (month and date only): _______  Address: ___________________________

City, State and Zip Code : __________________________________________________ 

Married:____Single:_____    Anniversary Date (month and date only): _______________

 E-Mail: ________________________  Fax: _____________________________

Phone: _________________          Occupation: __________________________________


Have you had previous ballroom dancing experience?______________________________


List interests, talents and hobbies such as singing, playing a musical instrument, photography,

woodcraft, etc.:_____________________________________________________________

Have you ever been a member of N.S.D.?_________

If so, what Chapter?__________________________________

Reason for withdrawal:_______________________________________________________

If called upon, would you be willing to serve in any office or on any committee or do other

work for the club? __________________________________________________________

To the best of your ability, will you attend regular monthly meetings and other meetings that     

may be necessary?_____________________________________________________________

By whom are you sponsored?____________________________________________________

Are you a legal resident of the United States?__________



Signature: _________________________________