The “Ballroom” On Nova Road, Inc.
465 South Nova Road, Ormond Beach, FL 32174 (Phone: 386-214-5539)
The Ballroom is a non-profit 501C(7)-all volunteer social dance club with a 14BC (alcohol) License.
Membership Application Membership Dues Are Per Person
Members are bound together by a common objective of Pleasure,
Recreation, Dance and other non-profit purposes.
Regular Annual Membership Dues $20
Annual Renewal Membership Dues $20
Name_______________________________________E-Mail:________________________
Name_______________________________________E-Mail_________________________
Rules:
1. Membership is restricted to individuals 21 years old or older.
2. Membership cards are not transferable, will be revoked if loaned.
3. Membership may be revoked at the discretion of the Executive Board.
4. Annual membership dues are from January 1 – December 31.
5. Annual Regular membership dues are $20.00 per person.
6. Annual Memberships expire December 31st each year.
Note: On special occasions the Ballroom will be closed to Members, their Family & Guest.
I agree to the membership rules & requirements outlined above and I certify that the information included
on this application is true and correct and that the applicant(s) listed above are over the age of 21.
______________________________________________ _________________________
Signature Date
Check #_________Cash_______ Amount Received $____________ Date Received _____________By_____
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