SHEN DANCE CLUB MEMBERSHIP FORM

PLEASE FILL OUT THE INFORMATION BELOW
NO PARTNER NECESSARY

RETURN TO MS. BRACKEN---HS EAST LIBRARY
EXT. 61507
BRACMARY@SHENET.ORG

************************************************************************************

PLEASE PRINT CLEARLY

                                NAME     ______________________________________________________________________________

                                HR TEACHER     ____________________________        TEL. NUMBER     _______________________

                                EAST OR WEST     ______________            GRADE     ______________      HOMEROOM #  ________

                                E-MAIL ADDRESS     ___________________________________________________________________
                                                                       PLEASE PRINT CLEARLY  !!!!

This page is maintained in accordance with Shenendehowa's web publishing guidelines by bracmary@shenet.org.   Last updated 10/10/07