The Ballroom, Inc., 1250 Hand Avenue, Ormond Beach, FL 32174
Membership Application Membership Expires 12-31-17
New Regular (Non-voting) Membership Dues $40 Lifetime (voting) Membership
Renewal Regular (Non-voting) Membership Dues $20 Requires $5,000 Donation,
Pro-Rated Semi-annually Plus Membership Dues
The Club is:
1. A Florida Not-For Profit Corporation, and is licensed by the Division of Alcoholic
Beverages & Tobacco for sale of liquor, beer and wine: A IRS tax exempt 501(c)(7) Social Dance Club,
organized for pleasure, recreation, dancing, personal contact, commingling, fellowship and
similar nonprofit purposes: Supported solely by Membership fees, dues, donations and
2. Will not discriminate against any person on the bases of race, color, or religion.
2. By paying my Membership Dues, I certify that I am Twenty-one (21) years old, or older,
and I will abide by all Local, County, State and Federal Laws and Club Rules & By-Laws.
3. Club Rules and Requirements:
a. Any Member or Guest displaying rude language, physical abusive actions or
generally disruptive behavior, will be asked to leave the Club.
b. Memberships may be revoked at the discretion of the BOD.
Name (First)___________________________(Last)_____________________________Member #_____
Signature:_________________________________________I Agree to the Club Rules & Requirements.
Name (First)__________________________(Last)______________________________Member #_____
Signature:_________________________________________ I Agree to the Club Rules & Requirements.
Paid on:___________________ Amount $____________________ Accepted by:_____________