Surf Ballroom Legacy Club Membership
Name
*
First Name
Last Name
Business Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Membership Level
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Rockstar
Surf Ballroom Legacy Club Membership: Rockstar Level
$
3,000.00
one-time payment
Headliner
Surf Ballroom Legacy Club Membership: Headliner Level
$
1,000.00
one-time payment
RENEWAL ONLY - Fan
Surf Ballroom Legacy Club Membership: Fan Level
$
500.00
one-time payment
Friend
Surf Ballroom Legacy Club Membership: Friend Level
$
100.00
one-time payment
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