ࡱ> ikh'` BIbjbjLULU 4^.?.?jjjjjjjdL RBBBB!,MiC E E E E E E $!hH$^i Ej]!]]i jjBB ///] jBjBC /]C //jj/B &̥_g"/l 0 /$$//$jCy"/yyyi i % yyy ]]]]      ~jjjjjj CLUB ROSTER ENROLLMENT FOR THE YEAR 2012. CLUB NAME FORMTEXT      COUNCIL: CALIFORNIA SQUARE DANCE COUNCIL  Association / Federation:  FORMTEXT Northern California Square Dancers AssociationName of Dancer (Last Name first, First Name last)Name of Dancer1.  FORMTEXT      22.  FORMTEXT      2.  FORMTEXT      23.  FORMTEXT      3.  FORMTEXT      24.  FORMTEXT      4.  FORMTEXT      25.  FORMTEXT      5.  FORMTEXT      26.  FORMTEXT      6.  FORMTEXT      27.  FORMTEXT      7.  FORMTEXT      28.  FORMTEXT      8.  FORMTEXT      29.  FORMTEXT      9.  FORMTEXT      30.  FORMTEXT      10.  FORMTEXT      31.  FORMTEXT      11.  FORMTEXT      32.  FORMTEXT      12.  FORMTEXT      33.  FORMTEXT      13.  FORMTEXT      34.  FORMTEXT      14.  FORMTEXT      35.  FORMTEXT      15.  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FORMTEXT      16.  FORMTEXT      37.  FORMTEXT      17.  FORMTEXT      38.  FORMTEXT      18.  FORMTEXT      39.  FORMTEXT      19.  FORMTEXT      40.  FORMTEXT      20.  FORMTEXT      41.  FORMTEXT      21.  FORMTEXT      42.  FORMTEXT      In accordance with the long established requirements of the USDA Insurance program and our insurance underwriters  All members of the club must participate in the United Square Dancers of America Insurance Program for the club to be covered under the liability policy. Please acknowledge compliance with this requirement by signing and returning this form: Signature: __________________________ Title: __ FORMTEXT      ______________ Date: __ FORMTEXT      ____ Number of Club Members this Page __ FORMTEXT      ___ Send Form and Check to Federation/Association Insurance Chairman 0B2BdBBvmm $IfgdWkd$$IflP0P)^ t0 )62 2 44 laytRTBBBBBBBBBBBBBBBBBBC CC C.C0C:C*jh^##h^##Uj#h^##h^##U h^##h^##jh^##h^##Uhhnh7h 7>* h 7h 7jh 7h 7Ujh 7h 7U&BBBBvmm $IfgdWkdo$$IflP0P)^ t0 )62 2 44 laytRTBB0CbCvmm $IfgdWkd $$IflP0P)^ t0 )62 2 44 laytRTbCdCCCvmm $IfgdWkd!$$IflP0P)^ t0 )62 2 44 laytRTCCCCCCCCCCCCDDDD,D.D0D:D*jh^##hHLUj"h^##hHLU h^##hHL)CCC.Dvmm $IfgdWkdC#$$IflP0P)^ t0 )62 2 44 laytRT.D0DbDDvmm $IfgdWkd$$$IflP0P)^ t0 )62 2 44 laytRTDDFdGfGJHLHHBIvqqqqqi^ $dha$gdWdhgd gd@|kd{&$$IflP0P)^ t0 )62 2 44 laytRTGGGGGGGHHH0H2H4H>H@HHHJHLH`HxHHHHHHHHH@IBIεڧzvo h hWhWjhvqUmHnHuj(hvqUhvqjhvqUhHLh h{h{5CJ\aJjh{UmHnHuj'h{Ujh{Uh{h@|jh@|UmHnHujh@|Uj/'h@|U21:pRT/ =!"C#h$% DText85Enter club's full name. Do not use any abbreviations$$If^!vh5 5"#v #v":V l t0 )6,5 5"2 2 ytRT$$If^!vh5 )#v ):V l t0 )6,5 )2 ytRTDText10.Northern California Square Dancers Association$$If^!vh5~5#v~#v:V l t0 )6,5~52 2 ytRT$$If^!vh5^5#v^#v:V l t0 )6,5^52 2 ytRT~DList each dancer in alphabetical order by last name. One person per line. 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