2017 Catalina Swim Club NEW Membership
Last Name
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First Name
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Street Address
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City
State
Zip Code
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Phone Numbers
Enter Phone# in Other example: 222-555-7777
Home Phone
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E-Mail Address #1
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E-Mail Address #2
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May we use your e-mail address to send you membership renewal forms, newsletters, etc.?
Please list all the names of family members living in household under 24, including parent(s). Single membership only need list member.
* Age and DOB will not be included in the Yearbook.
Parent/Spouse (First Name)
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Parent/Spouse (Last Name)
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Age
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DOB
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Parent/Spouse (First Name)
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Parent/Spouse (Last Name)
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Age
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DOB
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YYYY
Family Member (First Last)
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Age
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DOB
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YYYY
Family Member (First Last)
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Age
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DOB
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DD
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YYYY
Family Member (First Last)
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Age
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DOB
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YYYY
Family Member (First Last)
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Age
Your answer
DOB
MM
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DD
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YYYY
Family Member (First Last)
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Age
Your answer
DOB
MM
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DD
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YYYY
Family Member (First Last)
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Age
Your answer
DOB
MM
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DD
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YYYY
I hereby attest that the preceding membership information (e.g., Member Names, Family Members, Ages of Family Members, and Date of Births of Members and Family Members) is true, complete, and accurate. I acknowledge that if false information is provided that it could result in immediate revocation of my membership and forfeiture of my stock, initiation fee, and annual dues payment. I also, hereby attest that I am responsible for reading the Catalina Bylaw’s and Articles of Incorporation that are posted on the Catalina website: http://www.catalinaclub.org
NOTE: This attestation must be signed for your 2017 membership to be valid.
By Selecting YES you agree to the attestation
Payment Options
Membership Type
Payment Option
Full Payment must be received by May 1 in order to have your information in the yearbook and avoid a late fee.
NOTE: If an alternative payment schedule is needed, please contact Patrick Samuels at catalina@catalinaclub.org.
Full Payment must be received by May 1 in order to have your information in the yearbook and avoid a late fee.
If referred, name of Member who referred:
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Please send payments to:
Catalina Swim Club Coupon
Catalina Swim Club Coupon
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