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Membership Form
Membership Form
Eastgate Swim & Tennis Club membership form.
Primary Member Contact Info.
For family memberships, please enter the information for the head of household who will serve as the point of contact.
Member Name
*
First
Last
Home Phone
*
Ex: 555-555-5555
Work Phone
*
Ex: 555-555-5555
Cell Phone
*
Ex: 555-555-5555
Email
*
Address
*
Street Address
City
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
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Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Spouse Information
For family memberships, please fill out the following information for the non-primary contact head of household, if applicable.
Spouse Name
First
Last
Home Phone
Ex: 555-555-5555
Work Phone
Ex: 555-555-5555
Cell Phone
Ex: 555-555-5555
Email
Emergency Contact Info.
Please enter contact information for someone other than the party(ies) listed above who can be contacted in the event of an emergency.
Name
*
First
Last
Home Phone
*
Enter as 555-555-5555
Work Phone
*
Ex: 555-555-5555
Cell Phone
*
Ex: 555-555-5555
Email
Child Information
Please select the number of children in your family and fill out the corresponding information fields. If they plan to be a member of the swim and/or diving teams, please select the appropriate checkboxes next to their information.
Number of Children
0
1
2
3
4
5
6
7
8
9
10
Child One
Name
*
Date of Birth
*
MM
DD
YYYY
Team Registration
----
Swim Team -- $120
Dive Team -- $120
Swim & Dive Team -- $215
Child Two
Name
*
Date of Birth
*
MM
DD
YYYY
Team Registration
----
Swim Team -- $120
Dive Team -- $120
Swim & Dive Team -- $215
Child Three
Name
*
Date of Birth
*
MM
DD
YYYY
Team Registration
----
Swim Team -- $120
Dive Team -- $120
Swim & Dive Team -- $215
Child Four
Name
*
Date of Birth
*
DD
MM
YYYY
Team Registration
----
Swim Team -- $120
Dive Team -- $120
Swim & Dive Team -- $215
Child Five
Name
*
Date of Birth
*
MM
DD
YYYY
Team Registration
----
Swim Team -- $120
Dive Team -- $120
Swim & Dive Team -- $215
Child Six
Name
*
Date of Birth
*
MM
DD
YYYY
Team Registration
----
Swim Team -- $120
Dive Team -- $120
Swim & Dive Team -- $215
Child Seven
Name
*
Date of Birth
*
MM
DD
YYYY
Team Registration
----
Swim Team -- $120
Dive Team -- $120
Swim & Dive Team -- $215
Child Eight
Name
*
Date of Birth
*
MM
DD
YYYY
Team Registration
----
Swim Team -- $120
Dive Team -- $120
Swim & Dive Team -- $215
Child Nine
Name
*
Date of Birth
*
MM
DD
YYYY
Team Registration
----
Swim Team -- $120
Dive Team -- $120
Swim & Dive Team -- $215
Child Ten
Name
*
Date
*
MM
DD
YYYY
Team Registration
----
Swim Team -- $120
Dive Team -- $120
Swim & Dive Team -- $215
Dues and Payment Options
Please select a membership option by placing a check in the box(es) that apply.
Membership Options
*
Summer Family Membership -- $695
Summer Couples Membership -- $520
Summer Single Membership -- $420
Association Family Membership -- $570
Association Couples Membership -- $395
Association Single Membership -- $295
Book of Guest Cards
0
1
2
3
4
5
Price is $25 per book. Each book of guest cards contains five passes. One pass is required per visit, per guest.
Association Fees
Full Payment -- $500
1st Installment -- $250
2nd Installment -- $250
None due -- $0
Nanny / Sitter Fee
$35
Name
*
First
Last
Please enter the name of the Nanny / Sitter.
Total Membership Fee
The total amount for membership, team registrations, assocation fees and any other options selected above.
