2008 - 2009 Membership Registration
Please submit form by September 23, 2008 in order to be included in the Chi-Town member directory * = Required field
* First Name:
* Last Name:
* Street Address 1:
Street Address 2:
* City:
* State:	ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING
* Zip Code:
* Home Telephone:
Work Telephone:
Cell Telephone:
Home E-mail:
Work E-mail:
* Dance Level:	BeginnerMainstreamPlusA1A2C1C2C3C3AC4
Birthday (month and day):
Occupation:
Note: A link to the online version of the club newsletter, Spread & Circulate, will be sent monthly via e-mail. A limited number of print copies will be available at Chi-Town events for pick-up and only mailed to members without access to e-mail.
Membership dues are $40.00* * $25.00 if you live outside of the following area codes: 219, 312, 630, 708, 773, 815, 847
* Chi-Town membership payment: Check PayPal Cash
We are all volunteers. We need your help! Please indicate in which committees you would like to participate.
Classes Fund Raising Social/Dances Refreshments Decorations Crossfire Communications/Newsletter Community Outreach Pride Parade/Market Days Membership/Directory Recruitment Board Membership

If you are not using PayPal to pay for your registration, you may bring your payment to any
Chi-Town Squares function or mail to:

Chi-Town Squares c/o Membership Director PMB 167 5315 N. Clark St. Chicago, IL 60640-2113