2012 MEMBERSHIP FORM

First Name:

Last Name:

Address:

City:

Postal Code:

Phone Number:

Email Address:

Your email address will only be used to inform you of EBDA events and will not be available to other people or organizations.

I would like to help as a volunteer

No Yes

I would like to sit on the board of E.B.D.A.

No Yes

I acknowledge that dancing can be a vigorous activity and in no way hold Everyone's Ballroom Dance Association and/or their agent(s) liable for injuries and/or loss while participating in one of their activities.