Logan Dance Club

Membership Application Form

(to be submitted by active member)

 

Date_____________________________________________________________________

 

Member Submitting Referral___________________________________________________

 

Proposed Member Name & Address

 

Name(s)___________________________________________________________________

Address__________________________________________________________________

Home Phone_______________________________________________________________

Cell Phone_____________________________________________________________

Email__________________________________________________________________

 

Submit application to

Jeff & Lisa Anderson

1535 Mountain Road 

Logan, UT 84321

435-752-8497

lisaanderson03@comcast.net

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