Wedgewood Swim Club 2010 Membership Application

 

NAME:_____________________________________________________ DATE: ______________________________

 

Street Address: ______________________________City _______________ State _______ Zip ___________

 

Home Phone:______________________________  Email: _____________________________________________                                                                                        

 

                                                                                          

Family Members Full Names                                 Birth date                        Relation                           Price

             First & Last                                                                                       to adult 

 

1.                                                                                                                                                          (Adult) $200      

2.                                                                                                                                                                                   

3.                                                                                                                                                                                   

4.                                                                                                                                                                                   

5.                                                                                                                                                                                   

6.                                                                                                                                                                                   

7.                                                                                                                                                                                   

 

                                                                                                                                               Sub Total: ___________

                                                                 If subtotal is more then $395 only put $395 here:     ___________

                                                                 If after 5/31/10 add $25 late joiner fee       Total:        ___________

Membership Rates:

Adult: $200        Additional Adults: $100 each 

Children (1-17 years): $30 each        Full Time College Students: $50 each with proof

Membership Price Cap: $395  Your membership will not exceed $395

Late Joiner Fee: $25 If you are joining after May 31st, 2010

 

*All persons, on a single membership, must permanently live in the same home. 

Children and FT college students can not join alone.  A parent or guardian must be the primary adult member.  Full time college students must send in proof of full time status with this application.  Falsifying this application will result in the termination of your membership without refund.   Tags can be picked up the first day the pool is open.  Pictures will be taken for verification purposes.

 

Make check payable to: Wedgewood Swim Club.  Your cancelled check is receipt of payment. 

Mail completed application and payment to:                                   Phone: call Barbara at 325-2944

 

             Wedgewood Swim Club Memberships                                      

             c/o Barbara Hood                                                              Email: wedgewoodpool@hotmail.com

             12 Winburne Drive

             New Castle, DE 19720

 

Note:     Your cancelled check confirms receipt of your application.

With my signature, I attest that all of the information on my application is true and complete.  I understand that any false statements or omissions shall result in forfeiture of my membership without refund.

 

 

                                                                                                                                                                                                  

Signature                                                                                                     Date

 

Emergency Contact Information:

 

Name: ________________________________________   Phone: ___________________________________

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