SOUTH CAROLINA SQUARE & ROUND DANCE FEDERATION
CLUB INSURANCE INFORMATION

CLUB NAME: _______________________________________________

PLACE OF DANCE: _____________________________________________

Place of Dance: Address: ____________________________________

            CITY: _______________________________________SC__ZIP___________

DAY OF DANCE: __________________________

CALLER: _____________________________________________________

CUER/LINES: _________________________________________________

CLUB PRESIDENT: ______________________________________________

            ADDRESS:________________________________________________

            CITY:__________________________SC_ZIP_________ PHONE:________________

CLUB VICE-PRESIDENT: ______________________________________________

            ADDRESS:________________________________________________

            CITY:_____________________________SC_ZIP_________ PHONE:________________

CLUB SECRETARY: ______________________________________________

            ADDRESS:________________________________________________

            CITY:____________________________SC_ZIP_________ PHONE:__________________

CLUB TREASURER: ______________________________________________

            ADDRESS:________________________________________________

            CITY:______________________________SC_ZIP_________ PHONE:________________

CLUB FEDERATION REP: ______________________________________________

            ADDRESS:________________________________________________

            CITY:______________________________SC_ZIP________ PHONE:________________

CLUB INSURANCE CONTACT: ______________________________________________

            ADDRESS:________________________________________________

            CITY:_____________________________SC_ZIP__________ PHONE:_______________

            EMAIL ADDRESS:_____________________________________