100% CLUB

How would you like to have permanent recognition that your club participated 100% at the 
Annual Pennsylvania Square and Round Dance Convention.

To qualify for recognition that your club had 100% Registration at the convention:
1.  Provide a roster of all of your dues paying members in good standing (Charter members and/or Honorary members won't be counted).
2.  Have all of your members register for the Convention before May 31st.
3.  Mail all of the above to the Housing/Registration Committee Chairman with Application.
Deadline Date, June 15

If you Qualify, a recognition award will be on display at the Convention.  This award will be presented to your club president at the Saturday night ceremony.

---

We would like to be recognized as a 100% Club at the State Convention.

CLUB NAME:  __________________________ Federation: ______________________ 

ADDRESS:    __________________________________ 

            __________________________________ 

            __________________________________      

CLUB PRESIDENTS NAME: _______________________________________ 

PHONE #:   _______________________________________ 

NUMBER OF CLUB MEMBERS:  ________   Club Roster Enclosed: ____  Yes

Date Submitted: ___________________

Authorized Signature: _______________________________________