MEMBERSHIP INFORMATION

RENEWAL?      YES       NO                         Teacher Dancer

Name (Group or Individual): ___________________________________________

Contact Person: _____________________________________________________

Address: ___________________________________________________________

City: ____________________ Province: ___________ Postal Code: __________

Ph [H]: ______________________ [W]: ______________________

Ph [C]: ______________________ Fax: _______________________

E-mail: __________________________________________________

Website: _________________________________________________

Studio Affiliation: __________________________________________

Dance forms currently involved in as: a Dancer [D] or Teacher [T]
D / T      Yrs         Form                           D / T      Yrs       Form

_____   _____   ______________          _____   _____   ______________

_____   _____   ______________          _____   _____   ______________

MEMBER SIGNATURE ON BACK PAGE IS REQUIRED

For Youth Membership: Birth Date M:______ D:______ Y:______

Parents’ Names: _________________________________________

For Family Membership: List up to 4 additional Family Members
Name: _____________________________ <17 18-54 55 +
Name: _____________________________ <17 18-54 55 +
Name: _____________________________ <17 18-54 55 +
Name: _____________________________ <17 18-54 55 +

DSI MEMBERSHIP
  TYPE                            COST                              CRITERIA
Professional         $25                     Dancer • Choreographer • § Teacher • §
Youth                    $20                     17 & Under - A Parent’s signature is required.
Adult                    $25                      18-54 55 +
Family                  $35                        Maximum 5 persons
Group                   $35                        ____ # in Group ____ # < 17 ____ # 18-54 ____ # 55 +
Non Resident       $20                      -17 18-54 55 +

• Eligible for CDA Membership § Eligible for SOCAN Membership

CANADIAN DANCE ASSEMBLY
$45 Non-Affiliated $30 Affiliated Dance Professional $ 20 Affiliated Dance Artist $10 Student (non-voting)
Please check if you wish to receive The Dance Current at $25 (regular $34)

Affiliated membership requires that you are an active member of a regional dance service organization. Members may chose to participate in the initiatives begun by any CDA Standing Council based on their personal interest as professional dancers but must choose only 1 Council on whose initiatives they will be able to vote on.

DSI DIRECTORY & INTERNET SERVICES
NO, I do not want my information to be published in the Dance Saskatchewan Inc. Directory.
NO, I do not want my information to be available on the Dance Saskatchewan Inc. Website.
NO, I do not want to receive information about Dance Saskatchewan Inc., its events, programs and announcements via E-mail.

SOCAN LICENSE APPLICATION
Active Teacher Choreographer

SOCAN License $64.00 + GST $ 3.20+ DSI Admin Fee $ 2.80=
Total $70.00

License is legally required for active dance teachers and choreographers.

MEMBERSHIP FEES, DONATIONS & PAYMENT

I would like to help DSI continue its work in serving the dance community in Saskatchewan to make a charitable donation of:

$10 $25 $50 $100 or Other: $_______

Member Signature: ___________________________________________

Parents Signature: ___________________________________________

Payment: Cash Cheque Money Order Visa Exp. ___ /___

___/___/___/___ - ___/___/___/___ - ___/___/___/___ - ___/___/___/___

Name on Card: _________________________________________

Signature:______________________________________________

REFERRAL
Please send information about Dance Saskatchewan Inc. to my friend:

Name: ____________________________________________________________

Address: __________________________________________________________

City: _________________________ Province: ________ Postal Code: __________________

E-mail: ____________________________________________________________

DANCE SASKATCHEWAN INC.
CANADIAN DANCE ASSEMBLY
SOCAN

DANCE SASKATCHEWAN INC.
Mail: PO Box 8789 / Saskatoon, Saskatchewan / S7K 6S6
Office: 205A Pacific Ave / Saskatoon, Saskatchewan / S7K 1N9
Fax: 306.244.1520 Ph: 306.931.8480 In SK: 800.667.8480
Web: www.dancesask.com E-mail: dancesask@sasktel.net

Date: ___________________ Rect #:_______________ Done By: ________________

Zone: ________ SOCAN CDA Forwarded: ___________________

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