MEMBERSHIP APPLICATION

Print, fill out, and mail with membership fee ($21) to:
212 S. Elm Street
Greensboro, NC 27401

 

 

DATE__________ MEMBERSHIP#_____________________

NAME____________________________________________

ADDRESS_________________________________________

EMAIL___________________________________________

BIRTHDATE____________ DL#_______________________

GENDER  M  F  (CIRCLE ONE)

APPROVED BY_____________________________________

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INFERNO                                  

             

A true 70's Disco!