Northern Virginia Shag Club Membership Application

$25 FOR ONE YEAR MEMBERSHIP OR RENEWAL
Payable to Northern Virginia Shag Club, Inc.
PO Box 2298, Merrifield, VA 22116-2298








NVSC is a non-profit/volunteer club. We hope that all members will assist with club activities. If you have any interests or areas of expertise that you think the club could utilize, please indicate below.
Public Relations Fundraising Event Planning Photography
Financial Management Communications Dance Instructions Computer Skills
Other No Special Skills-But I'd like to help

Memberships renew one calendar year from the month that you joined. If you do not renew within 30 days, if/when you renew you will be considered a new member. Your new member status will affect your ability to run for the NVSC Board.

NVSC will not provide your personal information to any other organization, nor will a member use this information for any purpose other than club business.

The club makes occasional friendly telephone calls between the hours of 10 AM - 9 PM to remind you of upcoming events or changes to scheduled events. Check if you do not wish to receive these calls.
Do you have children or grandchildren (under 21) in our area who might be interested in learning to shag?


I AM 18 YEARS OF AGE OR OLDER, OR THE SIGNATURE OF A PARENT OR GUARDIAN APPEARS BELOW. I WILL ABIDE BY THE RULES AND BYLAWS OF THE NORTHERN VIRGINIA SHAG CLUB, INC. I UNDERSTAND THAT MY MEMBERSHIP MAY BE SUSPENDED OR TERMINATED BY THE CLUB AT ANY TIME FOR GOOD CAUSE, AND THAT THE CLUB WILL NOT BE RESPOSIBLE FOR ANY INJURIES OR DAMAGES TO ME OR MY PROPERTY DURING ANY CLUB FUNCTION. I AUTHORIZE THE CLUB TO USE MY NAME, BIRTH MONTH AND DAY AND/OR PHOTOGRAPHIC LIKENESS IN CLUB PUBLICATIONS AND THE CLUB WEB SITE.

Signature ________________________________________________________________________


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