DIVA SOCIAL & SOCIETY CLUB INC - (DETERMINED, INTELLIGENT, VIRTUOUS, ACHIEVERS)
DSSC Membership Application
Thank you for your interest in joining DSSC. Your Application will be reviewed by the DSSC committee and you will be contacted. Even though there is not a set criterion for membership all applications are reviewed before official membership is granted. All personal information is kept confidential. All referrals listed are only contacted via mail, with a membership invitation.
Full Name
Address
City
State
Zip
Date of Birth
Home Phone
Cell Phone
Email
Record of Education
High School
Check Years Attended
9th
10th
11th
12th
College
Check number of years attended
1
2
3
4
Vocational or Technical
Check number of years attended
1
2
3
4
Other (specify)
Check number of years attended
1
2
3
4
Occupation
Please list current occupation with brief description of duties
Interest
Talents
Dependents
Name
Age
Gender
If your dependent is a female would u like for her to be a member of our youth divison
Type your label here
yes
no
Friend Referrals
Name
Address
Phone
T-shirt Sizes
Small
Medium
Large
XL
XXL
XXL
XXXL
 
 
 
 
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