MASDA MEMBERSHIP/CHANGE OF ADDRESS 

NOTE: Use this form for membership renewal or change of address

MASDA membership for 2012 is $30.00 per year for singles or couples. Your membership includes four dances with Atlanta Area Callers and Cuers, two dances with National callers and 12 issues of FOOTNOTES. To insure uninterrupted delivery of FOOTNOTES, please renew by the 12^th of the month to receive next month's issue. The expiration date is shown in the top line of your mailing label.

[  ] NEW MEMBERSHIP       [  ] RENEWAL        [  ] CHANGE OF ADDRESS          CONTROL# _________ 

PLEASE PRINT

MEMBER(S)________________________________________________________________________
                                           LAST NAME                                                         FIRST NAME(S)

PRESENT ADDRESS__________________________________________________________________________
                                    STREET                                                              CITY                                                                     ZIP CODE

OLD ADDRESS__________________________________________________________________________
                                    STREET                                                             CITY                                                                     ZIP CODE

HOME PHONE__________________________ E- MAIL_____________________________________

ACTIVE MEMBER OF CLUB(S)___________________________________________________________________________
                                                                  NOTE:  YOU MUST BE A GRADUATED SQUARE OR ROUND DANCER

Make checks payable to MASDA and mail to:
                                                                                  

Pat Inglis  
1340 Oakengate Drive  
Stone Mountain, GA  30083