Membership Application

Jackson Ballroom Dance Club Membership Application

Last name

First name

Email

Mobile

Home Phone

Multi-line address

Country/Region

Address

City

Zip / Postal code

I authorize the publishing of my name and contact number in the club directory for the purpose of receiving updates about events and schedule changes: (this is voluntary)

After hitting submit below, please pay your $35 annual membership fee via Venmo to @Jackson-Ballroom or you can bring your cash / check payment to your next dance class.