Membership Registration for Masters Swim Team 2011-2012 Season Information on Member
Join Date:_____________________
__________________________________ __________ _____________________ Last Name, First Name, MI Sex (M/F) Birthday (mm/dd/yyyy)
__________________________________ ________________________________ Street Address City State Zip
__________________________________ ________________________________ Home Phone Email Address
__________________________________ _________________________________ Work Phone Occupation
Any medical considerations we should be aware of?
____________________________________________________________________
____________________________________________________________________ I ACKNOWLEDGE THAT BY REGISTERING FOR THE MASTERS SWIM TEAM I AM COMMITTED TO PAYING A FULL YEAR’S PROGRAM FEE OF $684. REGISTRATION FORM AND FIRST PAYMENT IS DUE BY OCTOBER 1, 2011.
Signature: ______________________________________
Name: _________________________________________Date: __________________ |