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Name(s)__________________                       Phone_______________

Street _______________________________________

City/Town__________________           State_____  Zip______

Summer Address (If Different):

Street __________________                          Phone________________

City/Town__________________           State_____  Zip______

FEE STRUCTURE: Please Check One

___Single Membership - $750

___Couple’s Membership (Spouse, Child, Significant Other) - $950

___Weekday (Monday-Friday) Membership - $550

___Weekday Couples’ Membership – (Spouse, Child, Significant Other)-$750

___Additional Children on Couple’s Membership - $50 each

(Children must be 20 years or younger and living at home, or a full-time college student as of March 1^st.)

___Junior Membership - $300

(Juniors must be 20 years or younger, or a full-time college student as of March1^st. College ID required.)