---- Club Sponsored Class -----
INSURANCE NOTICE
CLUB NAME
*
Please Select
BELLES & BEAUS
BLOOM-A-ROUNDS
CIRCLE CITY A SQUARES
DANCE AROUND
DO-SI-SQUARES
DOUBLE H
DYNAMIC DANCERS
FOOTLOOSE SINGLES
FRIENDSHIP ROUNDS
GREENWOOD MERRY MIXERS
HOOSIER CORNERS
INACTIVE
LAFAYETTE FUN SQUARES
LAUGHING SQUARES
MONDAY NIGHTS WITH TERESA
P + D SQUARES
PLAINFIELD QUAKERTOWN SHAKERS
RILEY WRANGLERS
STAR PROMENADERS
STAR RIGHTERS
SWINGIN' SINGLES
SWINGING MATES
TEN TO TWELVE
TIPS + SLIPS
WRECK TANGLED SQUARES
WRONG WAY SQUARES
NO CLUB
USDA #
*
BEGINNING DATE
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
ENDING DATE
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name of Dancer 1
Name of Dancer 2
Name of Dancer 3
Name of Dancer 4
Name of Dancer 5
Name of Dancer 6
Name of Dancer 7
Name of Dancer 8
Name of Dancer 9
Name of Dancer 10
Add 10 more dancers
Name of Dancer 11
Name of Dancer 12
Name of Dancer 13
Name of Dancer 14
Name of Dancer 15
Name of Dancer 16
Name of Dancer 17
Name of Dancer 18
Name of Dancer 19
Name of Dancer 20
Add 10 more dancers
Name of Dancer 21
Name of Dancer 22
Name of Dancer 23
Name of Dancer 24
Name of Dancer 25
Name of Dancer 26
Name of Dancer 27
Name of Dancer 28
Name of Dancer 29
Name of Dancer 30
Add 6 more dancers
Name of Dancer 31
Name of Dancer 32
Name of Dancer 33
Name of Dancer 34
Name of Dancer 35
Name of Dancer 36
Send form to Federation/Association Insurance Chairman.
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