WSSC-Logo-4CPlease 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 *
2nd Adult Member Name
E-mail *
2nd E-mail
Phone: *
-
Address *
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

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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