WSSC-Logo-4C* For initiation fee and stock holding members paying by credit card ONLY
* A 3% fee is added to cover credit card costs
* Please complete form and PRINT for your records BEFORE clicking submit .

2016 Membership Registration

Adult Member Name *
E-mail *
2nd Adult Member Name
2nd E-mail
Phone: *
-
Address *
Occupation:
  • Clicking the Submit button will take you to Paypal
  • Complete payment with credit card or Paypal
  • You do NOT need a Paypal account to pay by credit card
Membership type - select one: *
Child Name:(1)
Birth Date (1):
 /  / 
Child Name:(2)
Birth Date:(2)
 /  / 
Child Name:(3)
Birth Date:(3)
 /  / 
Child Name:(4)
Birth Date:(4)
 /  / 
Emergency contact Name and phone
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