Texas Coastal Bend Bellydance Association Membership Application

Membership Renewal________________

 New Member________________________________
 
Date ________________________________________________________________________

 Name________________________________________________________________________

Birthday: Month_____________Day_________________Age (optional)_______

Occupation____________________________________________________________________

Stage Name___________________________________________________________________   
 
Address______________________________________________________________________
 
Email________________________________________________________________________

 Phone _______________________________________________________________________

Membership Category:

Individual Membership $25.00________ (membership ONLY, no workshop)
Membership + Workshop/show $65.00_________ (includes 3hr Workshop w/ Silvia Salamanca, show ticket plus 1 year individual membership)

Additional Member at residence $5.00__________
Mailed Dunyana                        $6.00__________

Total:_________________________________________


Make checks payable to:  
  Texas Coastal Bend Bellydance Association

Mail to:   TCBBA      
                PO Box 18839    
                CC,TX 78468