ST. CHARLES SINGLES CLUB, LTD.

Join us for Dancing & many other Special Activities

Printer Friendly Application

Membership Application

____New      ____Renewal

Effective June 1^st dues are $25 per year.

 Renewals are due on or before the anniversary date!

 

PLEASE PRINT CLEARLY:                      In case of an Emergency, please notify:            

Name:                                                                      Name:                                                               

Address:                                                                  Telephone:(          )                                              

City:                                                                         Relationship:_______________________________ 

State:_______ Zip code:                                             E-Mail:____________________________________

Telephone:(          )                                                    Cell Phone:(          )                                              

Birth Date, Month:                     Day                           Male                Female            

The club is run entirely by volunteers.  Help is always needed. 

I give permission for photos that may include me in them to appear on the SCSC Web Site.

 

Signature:                                                                Date:________________________________________

Mail Application with check or money order to payable to St. Charles Singles Club, Ltd. at address below:

 

St. Charles Singles Club, Ltd.

P.O. Box 54

St. Charles, Il. 60174-0054