2008 - Springdale Area Recreation Club
Application for Membership
Contact Information - (919) 844-7752 or via email
Applicant Information Co-Applicant Information (Spouse)
Name:
Address:
City, State, Zip:
Subdivision:
Home Phone:
Email:
Profession:
Company:
Work Phone:
Name:
Email:
Profession:
Company:
Work Phone:
Family Information
Child's Name:
Child's Name:
Child's Name:
Child's Name:
Child's Name:
Child's Name:
Child's Name:
Birthday:
Birthday:
Birthday:
Birthday:
Birthday:
Birthday:
Birthday:
Emergency Contacts (for lifeguard use)
Name 1)
Name 2)
Phone No.
Phone No.
Payment Information
Initiation Fee ($500) + Annual Membership Fee ($450) = $950 First Year
Check the box to indicate how you would like to pay

  		Pay by Check
 

  		Pay Online (PayPal or Credit Card)
Note: An additional charge of $28.68 will be added to cover costs associated with online payment