Date____________________ [__]New Registration     [__] Renewal Registration

Primary Name of Team/Club_________________________________Date Organized________________

Additional Team Names (if applicable)_____________________________________________________

Location of Meet/Dance_______________________________________________________________

Number of Members: Club/Team Members________________________ TCC Members______________

Total estimated number of classes, workshops, exhibitions, etc. per year___________________________

Average age of members_____________ Average number of dancers @ performances_______________

From what organization do you subscribe to for BMI/ASCAP coverage?  Please check below.

        [__] American Callers Association   [__] C.L.O.G.         [__] Other_____________________________

Name of Club/Team Director/Voting Delegate #1 (Primary Contact):_______________________________

 Address___________________________________________________________________________

 City____________________________ State_____  Zip ____________-___________ (Must have +4 for Mailing)

 Daytime Phone #(____)______________________    Evening Phone #(____)____________________

Name of Voting Delegate #2 ____________________________________________________________
 
 Address____________________________________________________________________________

 City____________________________ State_____  Zip ____________-___________ (Must have +4 for Mailing)

 Daytime Phone #(____)____________________    Evening Phone #(____)__________________

NOTE:  VOTING DELEGATES MUST BE CURRENT INDIVIDUAL TCC MEMBERS.

 E-mail address for your team:

 Primary Name:______________________________ E-mail:______________________________________

 Secondary Name:____________________________E-mail:______________________________________

 Director: Please complete the Individual Membership Form and return both applications with respective fees to: