Individual Membership Application

USA Dance Inc.

Note Categories below

******* PLEASE PRINT CLEARLY *********

NAME(s)

DATE OF BIRTH

SIGNATURE(s)

DATE

 

 

 

 

 

 

 

 

MAILING ADDRESS

CITY

STATE

ZIP CODE

 

 

 

 

 

 

 

 

HOME PHONE

WORK PHONE

FAX

E-MAIL ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Is this a renewal application? ____ Yes _____ No

 

If Yes, Member # ______________________,      #________________________   

 

I wish to be assigned to: USA Dance Kitsap, Chapter 1025

 

MEMBERSHIP CATEGORY   (fees include chapter dues)

ADDITIONAL INFORMATION:

Ballroom Dancer

$35

$

Occupation:

Social Adult Dancer

$25

$

 

Social Youth Dancer

$10

$

Hobbies:

Social Dance Teacher

$50

$

 

 

 

 

Please check all applicable below - I am a:

Adult Athlete

$60

$

     Social Dancer

Student Athlete, 19 to 35

$20

$

     Competitor (American Style)

Minor Athlete, below age of 19

$15

$

     Competitor (International Style)

Professional Athlete

$65

$

     Competitor (Pro/Am)

DancsSport  Professional

$70

$

Proficiency Level (Circle Applicable Level)

DanceSport Special Olympics Athlete

$10

$

International: Bronze Silver Gold Novice / Pre-Champ / Champion

DanceSport Unified Sports Partner

$25

 $

American: Bronze Silver Gold Novice / Pre-Champ / Champion

Total Membership Fees

 

$

 

Total Contributions (as listed on the right):

 

$

Tax Deductible Contributions: 

Kitsap, Chapter 1025

$

CHECK TOTAL: Make check payable to

USA Dance Kitsap

$

TV Programs! Videos (National level)

$

Amateur Travel

$

Youth Programs: Chapter or National (Circle)

$

Are you willing to help your USA Dance Chapter as a volunteer? __ Yes __No

College Programs

$

General Fund: Chapter or National (Circle)

$

How are you willing to help?

Setup/Cleanup

Decorations

Dance instruction

Greeter at dances

Publicity

Dance Team

Other:

Make check payable to: USA Dance of Kitsap Peninsula

Please mail application & check to:

               USA Dance, Kitsap

               P.O. Box 3617

               Silverdale, WA 98383

 

Membership Categories

Recreational - Social

Ballroom Dancer $ 35 - This is NOT a competitor category.
Dances for enjoyment and works to improve but DOES NOT COMPETE. May include retired DS Athlete. While tangible benefit of Ballroom Dancer and Social Dancer are the same, those selecting this category have the satisfaction of knowing the difference in rate is donated to USA Dance to allow us to continue our work. Selection of this category is optional. This is not a competitor category.

Social Adult Dancer $ 25
Enjoys and appreciates the physical, mental, and social benefits of ballroom dancing

Social Youth Dancer $ 10
A social dancer under the age of 19. Often a family member or friend of adult member
(Note: Social Youth members do not receive the American Dancer magazine.)

Social Dance Teacher $ 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.

DanceSport: (Dancers who participate in dancesport competitions)

To all USA Dance Athletes - Be certain to keep your memberhsip current to avoid delays at competitions or possible disqualification.

Adult Athlete $ 60
A competitive dancer who is age 19 or above.

Student Athlete $ 20
A competitive dancer who is age of 19 or above but below age 35 and is enrolled in school full time.

Minor Athlete $ 15
A competitive dancer who is below the age of 19.

Professional Athlete $ 65
A competitive dancer who declares him or herself as a professional, or dances in a professional event or is registered as a Professional Member with a member organization of the WDC or IPDSC.

DanceSport Professional $ 70
An individual who serves in an official capacity,(i.e. judge, emcee, music director, invigilator, organizer, chairperson of judges, IDSF Adjudicator, etc.) in the field of DanceSport and/or ballroom dance.

DanceSport: Special Olympics Athlete $10.
Qualifies for participating in Special Olympics competitions only.

DanceSport: Unified Sports ® Partner $25.
Dance Partner of Special Olympics Athlete –for participating in Special Olympics only.