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___________________________
