Print out and complete this application or get the pdf brochure and bring it plus a check or cash to the Sundance Saloon (550 Barneveld Ave., San Francisco) any Sunday between 5:00 and 10:30 pm, or Thursday from 6:30 to 10:30 pm

or, mail the application with a check payable to:

The Sundance Association
2261 Market St., PMB 225
San Francisco, CA 94114

Today’s Date:  ______________________________________

First Name:  ____________________________________________

Last Name:  ____________________________________________

Address:  ____________________________________________

                 ____________________________________________

City, State: ____________________________________________

Zip Code, Country: _____________________________________

Phone:  ____________________________________________

E-Mail:  ____________________________________________

Check here if you wish to be listed as "Anonymous"

or listed as: ___________________________________________________

Membership Level: NEW RENEWAL

Turquoise ($40 - $59)
Copper ($60 - $119)
VIP Silver ($120 - $299)
VIP Gold ($300 - $599)
VIP Diamond ($600 - $1199)
VIP Platinum ($1200 +)

Amount enclosed:  $______________

Method of Payment:

Check (payable to The Sundance Association)
VISA MasterCard

     Acct no: ___________________________________________

     Exp. Date:_______________________

     Name on Card: ________________________________________

     Billing Address: ________________________________________

      ____________________________________________________

      ____________________________________________________

     Signature: ____________________________________________________

Shirt Size: (VIP members only):       S      M      L      XL      (circle one)

VIP Silver, Gold, Diamond or Platinum levels: Check here If you do NOT wish to receive a T-shirt.

All information provided is considered confidential and will be used only by The Sundance Association.