Tarnsfield Swim Club - 2012 Membership Form
Tarnsfield Swim Club
- 2012
Membership Form
Name_________________________________________________________Date____________________
Street_________________________________________City________________________Zip__________
Phone___________________________________email_________________________________________
| Description | Dollar amount
through 5/14/12 |
Amount Due |
| Family Membership | $529 | |
| Single Membership | $275 | |
| After 5 Membership | $225 | |
| Gold Membership* | $175 | |
| Senior Membership** | $65 | |
| August Membership*** | $175 | |
| Baby-sitters or grandparents watching children | $100 | |
| Extra Adults (living in the household) | $100 | |
| Total Amount Due $ |
*Gold membership is for those individuals
(couples only) that have been members for more that 10 years with no children
under the
age of 18. This membership DOES NOT extend membership to the member's
children over 18 years of age.
**Senior Membership is for those age 65 and above
***August Membership is only for those families that have never been a member of
the Swim Club.
_____________________________________________________________________________________________________
On the lines below, fill in the information for all members of the family
including name, relationship to member #1, baby-sitter (if applicable)
birth date, and indicate if member is a swimmer(S) or non-swimmer(NS). If
you have not provided a photo, please do so for member
cards. Write the name of individual on the back. The picture should
be 1 to 2 inches in size.
| Name | Relationship to #1 | Birth Date | S | NS |
__________________________________________________________
____________________
Signature
Date
Please make checks payable to Tarnsfield Swim Club and mail to
address below.
Tarnsfield
Swim Club, PMB 211, 798 Woodlane Road, Westampton, NJ 08060