USABDA INDIVIDUAL MEMBERSHIP APPLICATION
I affirm that I am an Amateur dancer.
I will support the alms and objective of USA Dance and the Olympic movement
Name_________________Date of Birth_________________Signature_________________
Name_________________Date of Birth_________________Signature_________________
Address: No & Street_________________________________________________________
City_________________________State______________________Zip__________________
Telephone (Home)_______________________Telephone (Work)______________________
Fax________________________Email______________________
How are you willing to help USA Dance?
_____________________________________________________________________________
_____________________________________________________________________________
Chapter______________________________________________________________________
Occupations__________________________________________________________________
Hobbies______________________________________________________________________
__Recreational __Competitor __Am Style __International __Pro-Am
Donations are tax-deductible.
This form may be used by two persons residing at the same address.
Please print clearly or type.
Send Application and a check payable to USA Dance to:
Peg Johnston, Membership Director
PO Box 4
Valrico, Florida 33595
813-685-1656
Membership Category (See Previous Page)
Ballroom Dancer x $35 =$________
Dances for enjoyment and works to improve but does
not compete. Selection of this category is optional.
Social Adult Dancer x $25 =$________
Enjoys and appreciates the physical, mental, and
social benefits of ballroom dancing.
Social Youth Dancer x $10 =$________
A social dancer under the age of 19.
Social Dance Teacher x $50 =$________
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.
Adult DanceSport Athlete x $60 =$________
A competitive dancer who is age 19 or above.
Student DanceSport Athlete x $20 =$________
A competitive dancer who is age of 19 or above but below
age 35 and is enrolled in school full time.
Minor DanceSport Athlete x $15 =$________
A competitive dancer who is below the age of 19.
Professional DanceSport Athlete x $65 =$________
A competitve dancer who declares him or herself as a
professional.
Dancesport Professional x $70 =$________
An individual who serves in an official capacity in the
field of DanceSport and/or ballroom dance.
DanceSport: Special Olympics Athlete x $10 =$________
Qualifies for participating in Special Olympics
competitions only.
DanceSport:Unified Sports Partner x $25 =$________
Dance Partner of Special Olympis Athlete - for
participating in Special Olympics only.
Other Member (specify) $________
Voluntary Contributions $________
Total Submitted $________
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