2019 New Member Application
This is for new members just joining. If you are looking for returning member dues, see the make a payment tab.

Instructions: Please complete in full the following application. Make payment/s to Nassau Swim Club either by mailing a check to P.O. Box 6, Yorktown, IN, 47396 or click the link here to pay via PayPal (*Additional Fees will apply). If you have any questions please contact us via e-mail at nassauswimcluborganization@gmail.com .
Email address *
In which way would you like to join? *
Applicant First Name *
Your answer
Applicant Last Name *
Your answer
Mailing Address *
Your answer
Spouse First and Last Name (if applicable)
Your answer
Names and birth dates of children living with you
Your answer
Primary Phone *
Your answer
Secondary Phone
Your answer
Baby sitter name ($25 for a summer baby sitter pass)
Your answer
Payment method *
Electronic Signature
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy