Dallas Push Club

214-TAG-PUSH  (214-824-7874)

Membership Application 

Name:  ______________________________    Date: ________________

Address: ____________________________________________________

City: ________________________   State: ___________  Zip: _________

Res. Phone: __________________   Bus. Phone:  ___________________

Email Address: _______________________________________________

Amount: ________________  (Membership dues are $70 per calendar year)

Birthday (Month/Day Only): ____________________

Mail Completed Application and Dues (check made payable to Dallas Push Club) to Terry Rippa, 502 Lakeside, Mesquite, Texas 75149

May we publish this address (Yes ___;  No ___) and/or phone number (Yes ___; No ___) with our member directory in the Nov/Dec issue of the Dallas Push Club Newsletter?

Those join the Dallas Push Club and pay dues for calendar year 2008 prior to August 1, 2008, will receive a free ticket to Dallas D.A.N.C.E. 2008. Your FREE ticket will be available for pickup at the "will-call" table Labor Day Weekend and is non-transferable.