NOTE: The Chapter to which you have applied for membership will advise you as to the amount of membership dues and fees you must pay to both the Chapter and the National Organization.

In compliance with the requirements of membership, the applicant agrees to take examinations in the subjects of dance he or she wishes certification. The applicant’s examination shall be evaluated by a minimum of two examiners who are members of the Dance Masters of America. Their decision of the grade percentages shall be accepted by the Organization.

The Dance Masters of America, Inc. prohibits discrimination on the basis of race, color, religion, creed, sex, marital status, sexual orientation, national origin or disability in the treatment of participants in access to or content of its programs and activities.

Mailing Address_________________________________________________________________________________________

City _______________________________________ State __________________ Zip Code _______________________

Home Phone (Area Code) ___________________________________________________________________________

Studio Phone (Area Code) ___________________________________ Fax _____________________________________

E-mail: ________________________________________________________________________________________

Date of Birth ___________________________  Number of Years Teaching Dance_____________________________

If No, List the School(s) where you are currently employed Teaching Dance:

________________________________________________ _______________________________________________

________________________________________________ _______________________________________________

List the dance subject(s) you actively teach at this time:

________________________________________________ _______________________________________________

________________________________________________ _______________________________________________

________________________________________________ _______________________________________________

Have you ever applied for membership to DMA, Inc.____________________________________

If Yes, Please give the name of the Chapter to which you applied and Your name as shown on your membership application.

Chapter No. _______ Year applied ____________ Name_______________________________

List the Schools/Teachers you have studied with and the length of time with each.

1.__________________________________________from____________________to________________________

2.__________________________________________from____________________to________________________

3.__________________________________________from____________________to________________________

4.__________________________________________from____________________to______________________

5.__________________________________________from____________________to________________________

With the signing of this application, I hereby agree to take the examination(s), given by the appointed members of the examination committee for the Dance Masters of America Chapter No. __________. The passing of these examinations, with a grade of not less than seventy-five (75%) percent, shall be one of the pre-requisites for membership in the Dance Masters of America Organization.

Recommendations and Signatures of two Dance Masters of America members in good standing are required.

1. _________________________________   2._________________________________

════════════════════════════════════════════════════════════════════

This section must be completed and signed by the Chapter Secretary before it is sent with Chapter check for national dues payment and copies of examinations to the office of the National Executive Secretary.

Date Application Received _________________ Date of Examination___________________

Date of Chapter Approval _______________________________

Signature of Chapter Secretary__________________________________________________________

This section must be completed and signed by the Examiners.

════════════════════════════════════════════════════════════════════

We, the undersigned, do hereby affirm, that the above named applicant has passed with a satisfactory grade, the Dance Masters of America examination(s) and has proven his/her qualifications as a bona fide teacher of the dance subjects indicated below with score.