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


Diana & Truman Hershberger
257 Homan Ave.
State College, PA 16801
Home: (814)-238-6880
Cell: (814)-935-4133

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: _______________________________________