Steppin' Country Membership Application

                2016/2017

 

Name          _______________________________________________

Spouse:       _______________________________________________

Address:      _______________________________________________

City:            _______________________ State: ____ Zip Code: _______

Telephone:   _______________________

Email:          ________________________________________________

Birth date:   _________________    Spouse's birth date: ______________

Anniversary: _________________

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Children under 18 residing in household: (Only if applying for Family Membership)

Name: ____________________________________________  Birth date: ____________

Name: ____________________________________________  Birth date: ____________

Name: ____________________________________________  Birth date: ____________

Name: ____________________________________________  Birth date: ____________

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Membership Dues:

Regular Membership:  $20.00 per individual member / per year  (October 1st to September 30th)

Family Membership:  $40.00 per family residing in the same household / per year  (October 1st to September 30th)

Please send check and membership application to:

Steppin' Country

P.O. Box 2012

Walla Walla, WA 99362

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Additional Comments: