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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.
* Indicates required question
Email
*
Your email
Primary Member Name / Birthday / Address
*
Your answer
Additional Adults (18+) / Birthday / Address
Your answer
Child Membership Name / Birthday / Address
Your answer
Outside Primary Address Membership (Caregiver/Grandparent) Name/ Birthday /Address
Your answer
Email
*
Your answer
Phone Number
*
Your answer
Reference: Two (2) Bonded/Partial Bonded Nassau Members
*
Your answer
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