Membership Form
Please complete the required information below and submit the form.  

Then from our website, you may pay your membership dues via Zelle or Venmo, or pay in person at the bar with cash, or with a check made out to Southern Country Charlotte.

Once your payment is received, you will receive your membership card at our next Country Night dance.

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New or Renewing Member? *
Preferred Name *
Last Name *
Birthday Month and Day *
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Email Address *
Mobile Phone *
Questions or Comments (optional)
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