NWCA Membership Registration – Northwest Clogging Association

Membership includes:

Membership and Insurance is good from January to December without pro-ration. All currency is USD.

Adult USA membership includes Insurance and Newsletter Access. Adult Canadian membership includes Newsletter Access, but not Insurance.

First Name *

Last Name *

Email Address *

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Club Name *

Cuer / Instructor *

Accidental Medical Insurance - are you covered by another clogging or square dance group? If yes, add the group name.

Membership TypeAdult - USA - $15Adult - Canada - $10Youth (Under 18) - USA - $7.5Youth (Under 18) - Canada - $5

Payment Total