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
Emma Lou Shaffor
125 Jackson St.
Indiana, PA 15701
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: ______________________
CLUB PRESIDENTS NAME: _______________________________________
PHONE #: _______________________________________
NUMBER OF CLUB MEMBERS: ________ Club Roster Enclosed: ____ Yes
Date Submitted: ___________________
Authorized Signature: _______________________________________