Club name:      
Country:        
                       USA
                       Argentina
                       Austria
                       Australia
                       Belgium
                       Brazil
                       Canada
                       Denmark
                       France
                       Germany
                       Greece
                       Israel
                       Italy
                       Japan
                       Mexico
                       Netherlands
                       New Zealand
                       Norway
                       Philippines
                       Portugal
                       Russia
                       Spain
                       Sweden
                       Switzerland
                       Turkey
                       United Kingdom
		       Other (give country in "city")
		       
State (if USA): 
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Other USA
Other Country
                       
City:           

Address (where the club meets):
                

Contact info (phone, email, web page, ICC handle):
                

Meeting times:  

Comments, directions, description of activities: