TWIN RIVERS SHAG CLUB
P. O. Box 13006
New Bern, North Carolina 28561
Sanctioned by Association of Carolina Shag Clubs (ACSC)
Application for Membership/Renewal
Date ____________ New Member $20 Renewal $15 (Please Circle one)
Name (please print) _______________________________________________
Mailing Address _______________________________________________
City, State, Zip Code _______________________________________________
Email Address _______________________________________________
Phone (main) ______________________ (other) _______________________
Date of Birth _____________ (month/day) Place of Birth ____________________
Business Affiliation _____________________________________________
Address ______________________________________________
City/State/Zip ______________________________________________ Background Information (include hobbies, special interests, family)
____________________________________________________
____________________________________________________
We are a volunteer club. Please indicate if you would work with one or more of these committees:
(circle) Membership Ways & Means Publication Activities Hospitality/Sunshine Party
Sponsor _____________________________ ___________________________
(Please Print) (Sponsor Signature)
MEMBERSHIP MEETINGS ARE HELD THE SECOND SUNDAY OF EACH MONTH AT:
6:00pm at: Attitudes Pub & Grille, 32 Shoreline Drive, River Bend, NC
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