ALMOST HEAVEN WV SHAG DANCE CLUB
P.O. BOX 102
CLARKSBURG, WV 26302

MEMBERSHIP APPLICATION

PLEASE READ CAREFULLY -- PRINT ALL INFORMATION

MEMBERSHIP FEE MUST ACCOMPANY THIS APPLICATION
NAME __________________________________________________                                                                                                               

MAILING  ADDRESS ________________________________________________                                                                                               

CITY ____________________________   STATE  ______     ZIP    ______________________                            

PHONES (HOME) ___________________ (WORK) _________________   (CELL)_______________                         

EMAIL  ____________________________________                                                                                                              

BIRTHDATE ______________________________          OCCUPATION   ____________________________                                                     

ALMOST HEAVEN WV SHAG DANCE CLUB MEMBERSHIP PROVIDES YOU WITH THE FELLLOWSHIP, AND FUN OF DANCING, SHAG LESSONS, FREE AND
NEARLY FREE PARTIES, NEWSLETTERS, EMAIL NOTICES, UPCOMING SHAG EVENTS IN YOUR LOCAL COMMUNITY AND SURROUNDING AREAS

RULES:
1.   Membership is restricted to individuals 21 years old or older.
2.   Membership may be revoked at the discretion of the Executive Board.
3.   Membership cards are not transferable.
4.   Annual membership dues are from January 1 – December 31, of the same year.
5.   All memberships expire December 31 each year.
6.   Renewal annual dues are $20.00 per person if paid by December 31.
7.   New member dues are prorated per person for each new membership at any time.

**PLEASE READ THESE POLICIES AND DIRECTIONS**
  • ALMOST HEAVEN WV SHAG DANCE CLUB  is not designed to be an avenue to give money to charitable causes. This is a social club. Funds raised by
    the club during the year are used for expenses incurred by the club, for the benefit of the club’s members and to aid in the prosperity and future
    of the Almost Heaven WV Shag Dance Club.
  • Members are encouraged to be active, attend club meetings, and to help with the various committees, activities, and functions the club supports
    and/or hosts during the year. We recognize that everyone can’t always do or be at everything. But, we believe every member can and should do
    various things to help during the year.
  • RELEASE: FOR AND IN CONSIDERATION of dues paid for membership to the Almost Heaven WV Shag Dance Club I, the undersigned, being of lawful
    age, do hereby release and forever discharge Almost Heaven WV Shag Dance Club, from any and all causes of action, claims, and demands for,
    upon, or by reason of any damage, loss, or injury, which heretofore has been or while will hereafter be sustained by me as a consequence of
    attendance at Almost Heaven WV Shag Dance Club sponsored functions. It is understood that the act of admission to Almost Heaven WV Shag
    Dance Club sponsored functions as a member is not construed as an admission on the part of Almost Heaven WV Shag Dance Club any liability to
    me whatsoever for any personal injury or loss.

I submit my application and agree to the terms above on this date                         .

                            
Applicant Signature___________________________________________
Almost Heaven WV
Shag Dance Club