Membership Application

Summerville Shag Club Membership Application

New Members $20 Renewals $15

Name_____________________________________________

Address___________________________________________

City______________________State_______Zip___________

Ph# Home ____________Cell____________Work__________

Member Birthday_____________________

E-Mail Address______________________________________

Profession/Occupation________________________________

Summerville Shag Club encourages all members to support our club 

Name tags available for order $6. Check box for style

Name_____________________________________

Clip____________     Magnetic________________

Checks payable to:  Summerville Shag Club

Mail Application/Check to:

Summerville Shag CLub

100 Sawmill Drive,  Summerville, SC  29483

Date___________Member signature___________________________

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