Swingin' Singles Membership Application
Print CLEARLY the completed application and return application and fees at a dance
or mail to: Mary Kay Riehle, 11415 W 49th Terrace, Shawnee, KS 66203-1031
913-631-6086 – Cell 913-302-8390
Name: Birth Date MM-DD  
Address:
City: St:  Zip + 4:
Phone: Email:
Cell Todays Date
If you have internet access, do you want the newsletter emailed to you?

Check where applicable:
New Applicant Renewal Annual Renewals are due September 1
Annual Membership Dues $ 5.00
Insurance (see note below) $ 4.50
Swingin' Singles Name Badge $ 6.00
Do you want the newsletter mailed to you? $10.00
Fed Facts Subscription - Annual is $18.00 $18.00
(pro-rated after December - $1.50 per month will be subtracted from total)
Kansas TRAVEL-ON Magazine (4 issues per year) $17.00
Missouri Doin’s Magazine
$15.00
Click for Total Amount
Make checks payable to Swingin' Singles

If your insurance is paid though another club, please indicate the name of the club:
Would you serve on a committee? Would you serve as an officer?

For New Members:  Sponsor:
                     Board Member:

Note: It is required that all members of Swingin' Singles have the insurance provided through the Heart of America Federation of Square Dance Clubs.  Swingin' Singles must have 100% of its members insured through our club or another Federation club to be eligible for Liability insurance.

The Swingin' Singles reserves the right to refuse membership to anyone whose presence of conduct is deemed by the Board not to be in the best interests of the Club or Square Dancing fellowship. (Bylaws Article III, Section 4 & 5)

Please note: There will be a $20 Charge for Returned Checks.