2018 Catalina Swim Club Membership Renewal
Email address *
Last Name *
Your answer
First Name *
Your answer
Did your Address change? *
Street Address *
Your answer
City *
State *
Zip Code *
Your answer
Did your Phone Number change? *
Phone Numbers
Enter Phone# in Other example: 222-555-7777
Home Phone *
Cell Phone *
Did your Email change? *
E-Mail Address #1
Your answer
E-Mail Address #2
Your answer
May we use your e-mail address to send you membership renewal forms, newsletters, etc.? *
Did your Family Members change? *
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) *
Your answer
Parent/Spouse (Last Name) *
Your answer
Age *
Your answer
DOB *
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Parent/Spouse (First Name)
Your answer
Parent/Spouse (Last Name)
Your answer
Age
Your answer
DOB
MM
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DD
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YYYY
Family Member (First Last)
Your answer
DOB
MM
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DD
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YYYY
Family Member (First Last)
Your answer
Age
Your answer
DOB
MM
/
DD
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YYYY
Family Member (First Last)
Your answer
Age
Your answer
DOB
MM
/
DD
/
YYYY
Family Member (First Last)
Your answer
Age
Your answer
DOB
MM
/
DD
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YYYY
Family Member (First Last)
Your answer
Age
Your answer
DOB
MM
/
DD
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YYYY
Family Member (First Last)
Your answer
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 2018 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.
Please send payments to:
A copy of your responses will be emailed to the address you provided.
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