Monroe Shag Club Membership Application

Enter the date of application:

-- mm/dd/yy

Choose one of the following options:

New Member
Renewal

Please provide the following contact information:

First Name
Last Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
E-mail

Enter your birth date:

Enter your anniversary date (if applicable):

Please provide the following contact information for your spouse (if applicable):

First Name
Last Name
Work Phone
E-mail

Enter your spouse's birth date:

Please select any of the following committees on which you would be willing to serve:

Social Committee
Membership Committee
Ways and Means Committee
Shaggin' for Dollars Committee
DJ Selection Committee

Annual Membership: $25.00/person or $40.00/couple - (Membership runs January 1 - December 31). Membership benefits include reduced SOS tickets, reduced cover charge for MSC dances, free admission to MSC's Christmas Dance (provided payment for renewal of membership is received by December dance), and monthly issues of the MSC's, "Shaggin' Good News". Make check payable to Monroe Shag Club. Mail payment to:

Monroe Shag Club, P.O. Box 3202, Monroe, NC 28111.

The Membership Chairperson will be contacting you regarding your application.

Thank you!!