Nassau Membership Request Form
Please provide below information for estimated membership dues.
*Current membership capacity may require new member requests to be placed on a waiting list.
Email *
Primary Member Name / Birthday / Address *
Additional Adults (18+) / Birthday / Address
Child Membership Name / Birthday / Address
Outside Primary Address Membership (Caregiver/Grandparent)                                                    Name/ Birthday /Address
Email *
Phone Number *
Reference: Two (2) Bonded/Partial Bonded Nassau Members *
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