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
------------------------------------------------------------------------------------------------------------------------------------
keep bottom portion for your records

Date________________ amount paid $________________________

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