USABDA INDIVIDUAL MEMBERSHIP APPLICATION I affirm that I am an Amateur dancer. I will support the alms and objective of USA Dance and the Olympic movement
Name_________________Date of Birth_________________Signature_________________ Name_________________Date of Birth_________________Signature_________________
Address: No & Street_________________________________________________________ City_________________________State______________________Zip__________________ Telephone (Home)_______________________Telephone (Work)______________________ Fax________________________Email______________________ How are you willing to help USA Dance? _____________________________________________________________________________ _____________________________________________________________________________
Chapter______________________________________________________________________ Occupations__________________________________________________________________ Hobbies______________________________________________________________________
__Recreational __Competitor __Am Style __International __Pro-Am
Donations are tax-deductible. This form may be used by two persons residing at the same address. Please print clearly or type.
Send Application and a check payable to USA Dance to: Peg Johnston, Membership Director PO Box 4 Valrico, Florida 33595 813-685-1656
Membership Category (See Previous Page) Ballroom Dancer x $35 =$________ Dances for enjoyment and works to improve but does not compete. Selection of this category is optional. Social Adult Dancer x $25 =$________ Enjoys and appreciates the physical, mental, and social benefits of ballroom dancing. Social Youth Dancer x $10 =$________ A social dancer under the age of 19. Social Dance Teacher x $50 =$________ An individual who is engaged in the teaching of social dance who does not compete as a professional and does not instruct those who will be competing in USA Dance Events. Adult DanceSport Athlete x $60 =$________ A competitive dancer who is age 19 or above. Student DanceSport Athlete x $20 =$________ A competitive dancer who is age of 19 or above but below age 35 and is enrolled in school full time. Minor DanceSport Athlete x $15 =$________ A competitive dancer who is below the age of 19. Professional DanceSport Athlete x $65 =$________ A competitve dancer who declares him or herself as a professional. Dancesport Professional x $70 =$________ An individual who serves in an official capacity in the field of DanceSport and/or ballroom dance. DanceSport: Special Olympics Athlete x $10 =$________ Qualifies for participating in Special Olympics competitions only. DanceSport:Unified Sports Partner x $25 =$________ Dance Partner of Special Olympis Athlete - for participating in Special Olympics only. Other Member (specify) $________ Voluntary Contributions $________ Total Submitted $________