Amended November 11, 2006
APPLICATION FOR MEMBERSHIP
IN THE
GEORGIA ROUND DANCE TEACHER’S ASSOCIATION
APPLICATION FOR MEMBERSHIP
IN THE
GEORGIA ROUND DANCE TEACHERS ASSOCIATION
NAME: ______________________ ______________________ ______________________
HERS HIS LAST
ADDRESS:___________________________ _____________________ ________________ _______
STREET CITY STATE ZIP
TELEPHONE: HOME : (____)________________ BUSINESS: (____)________________________
Application is for Full Membership _______ Associate Membership _______
(Requirements are specified in the By-Laws)
Qualifications: Began Round Dancing in ________________ (year)
Began Teaching R/D in __________________(year)
Have taught _____ Beginner Classes of _____lessons each.
Do you have a BMI/ASCAP License? _____ Yes _____ No
Teach and cue regularly for R/D Clubs as follows:
Club Name Day & Time Where Level
____________________________ ________________ ____________________ _______
____________________________ ________________ ____________________ _______
____________________________ ________________ ____________________ _______
Cue regularly for the following S/D Clubs
_____________________________________________________________________________
_____________________________________________________________________________
MEMBERSHIP FEE - $10.00 per person yearly Amount: $___________
REQUESTING ____ BADGES - $ 6 Each (Pin) $8 Each (Magnet) Amount: $___________
TOTAL TENDERED: $___________
I/WE agree to support and promote the ethics of GRDTA and all GRDTA functions.
Signed_______________________________ Signed___________________________
Date_________________________________ Date ___________________________
RECOMMENDED BY GRDTA MEMBERS: ______________________ _______________________
APPROVED BY: ___________________________ MEMBERSHIP COMMITTEE VOTE: _________
GRDTA