2017 PURCHASE POOL MEMBERSHIP APPLICATION

 

 

 

 



List below, all FAMILY MEMBERS, defined as "Two adults and their children living in the same single family household", to be included on your Membership. (Extended Family members such as Grandparents, Aunts, Uncles, Nieces, Nephews, etc. must obtain their own membership.)

FIRST NAME
LAST NAME
DOB
RELATIONSHIP

 

Enter Caregiver Information below. Caregivers are added to the membership for $100/person.

Leave section blank if no Caregivers are on the membership.

FIRST NAME
LAST NAME
DOB
RELATIONSHIP

Base Membership Fee is $750

Membership Discounts (check all that apply):


Total Fee: $750

or