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:__________________