Information Update 2018
In an effort to keep our records up to date, please fill out the information below and return along with your payment. Please ensure emergency contact is someone not currently on your membership. If the below information changes in the future, please contact the Billing Office or Front Desk to update your records.
Thank you in advance for your assistance. Please feel free to call the Billing Office at (360)352-6082 should you have any questions.
Primary
Name *
Your answer
Email *
Your answer
Would you like to enroll in paperless statements? *
Address *
Your answer
Phone number *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Emergency contact *
Please provide an emergency contact's Name, Phone Number, and Relationship
Your answer
Co-Applicant *
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