Names:________________________________________________________________________

Summer:________________________________________________________________________

                                                Street                                                                           City                                   State/Zip

Winter: ________________________________________________________________________

                                                Street                                                                            City                                     State/Zip

Phone:_______________________________

Email: ________________________________

1. ☐$100 Couple
   

2. ☐$150 Sustaining Membership
   

3. ☐$50 Individual / $35 17-30yrs.
   

4. ☐$70 Couple 17-30 years old
   

5. ☐$75 New couple

Application for Membership for the 2023 Summer Dance Club

Mail to:

Lakeside Dance Club

Barbara  Benson

508 E Lake Cowdry Rd NW

Alexandria, MN 56308

      To join:

• Print this page

• Complete form

1. •Make check to:
   

2. •“Summer Dance Club”
   

3. •Mail form & check:
   

Email the Summer Dance Club danceclub@lakesideballroom.org