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Rainbow Dancers
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RAINBOW DANCERS MEMBER APPLICATION

Name ____________________________________________________ Date________________________
(please print)

address __________________________________________________________
 
phone (_______) ____________________

city ____________________________________________________________
 
state _______________ zip code _________

e mail _____________________________________________
 
check one - renewal [] new member []

Enclosed is [] $15.00 single membership []

[] $25.00 family membership
 
{} I have enclosed $                    donation to help the Rainbow Dancers
 All donations are tax deductible.

Mail application with remitance to: Rainbow Dancers
11516 Duval Rd.
Manito, IL. 61546
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keep bottom portion for your records

Date________________ amount paid $________________________

Rainbow Dancers
A registered 501-3c non profit corporation.


Rainbow Dancers - People who care about doing things right, and in a good way.