Full Membership form

Please complete form and print for your records BEFORE clicking Submit button.

This form is for Full Stock or Initiation fee Members – Paying by Check

      
                                                                                                                                                                                                                                                                                                                                                                                                                                
2016 Membership Registration
Adult Member Name *
First Last
2nd Adult Member Name
First Last
E-mail *
2nd E-mail
Phone: *
- 
Area Code Phone Number
Address *
Street AddressStreet Address Line 2CityState / Province / RegionPostal / Zip Code
Occupation: 
Important: Please fill out the form completely and 
PRINT before pushing Submit.
Mail check with payment to:
Membership Secretary
West Side Swim Club
P.O. Box 44004
Madison, WI 53744-4004
type_submit_reset_12 
Membership Type - select one *
Family Membership  ($695)
Couple Membership ($485)
Individual Membership ($360)
Emeritus Family 12+ years active ($595)
Social Member - come to our parties! ($75)
Inactive Member - retain membership ($25)




Child Name:(1) 
First Last
Birth Date (1):  /   /  
day month year
Child Name:(2) 
First Last
Birth Date:(2)  /   /  
day month year
Child Name:(3) 
First Last
Birth Date:(3)  /   /  
day month year
Child Name:(4) 
First Last
Birth Date:(4)  /   /  
day month year
Emergency contact Name and phone
Comments