ECR Registration Form

Required Information

This is information we need about you for club business like elections and insurance.

If you don't want specific personal information shown in the club directory, you can opt out by checking the appropriate boxes.

Your Name
First Last

I do not want to be listed in the ECR Club Directory

Street Address

City State ZIP

I do not want my home address shown in the ECR Club Directory

Email Address

I do not want my email shown in the ECR Club Directory

Current Dance Level (select one)

Other Square Dance Clubs You Belong to

I do not want my other clubs shown in the ECR Club Directory

IF YOU BELONG TO ANOTHER SQUARE DANCE CLUB, which club do you want to designate as your "primary" or "home" club for insurance purposes?
El Camino Reelers or

Optional Information

A little more about yourself for the club directory. If you aren't comfortable sharing any of this information, just leave the fields blank.

Home Phone

Work Phone

Mobile Phone

Birthday Month Day

Occupation (or fanciful title indicating lack of same)

New members: How did you hear about El Camino Reelers?

Your registration form will be sent to treasurer@reelers.org