Beach Club Registration
Member Information
Primary Member
*
First Name
*
Last Name
*
Birthdate
*
Sex
M
F
*
Address 1
Address 2
*
City
*
State
*
Zip
*
Home Phone
Alternate Phone
*
Email Address
Beach Club Prices
Family Membership: Parents, Children, Grandparents = $200
Individual Membership = $150
Parents who participate in Playmates Learning Center & Sandlot Sports programs
get a $50 discount on beach membership!
*
Please select all that apply for your 2011 Summer Package
Family Membership
Individual Membership
PLC/Sandlot Family Discount
*
Total Fees $
Included Family Members
Family Member #2
First Name
Last Name
Birthdate
Sex
M
F
Family Member #3
First Name
Last Name
Birthdate
Sex
M
F
Family Member #4
First Name
Last Name
Birthdate
Sex
M
F
Additional Family Members
Family Member #5
First Name
Last Name
Birthdate
Sex
M
F
Family Member #6
First Name
Last Name
Birthdate
Sex
M
F
*
Indicates Response Required