SOUTH CAROLINA SQUARE & ROUND DANCE FEDERATION
CLUB INSURANCE INFORMATION
CLUB NAME: ______________________________________________________
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:__________________