Surreywood Swim & Tennis Club Membership Form - 2016
Fill out the information on this page, select request invoice on this form to get an emailed invoice or send in your membership payment via postal mail. Payment can be made in full or in 3 easy payments (by 2/15, 3/15 and 4/15). Memberships are not active until payment in full has been received and membership details have been reviewed and approved.
Billing Name, (Last , First)
Alternative Family Name(s) (if multiple last names)
Select all that apply. For membership type details go to
Member - Family ($385) / covers all persons living in the same residence
Member - Couple ($330) / covers two people living in the same residence
Member - 55+EN w/o grandchildren ($275) / covers two people age 55 or older
Member - 55+EN w/grandchildren ($325) / covers two people age 55 or older and their children and grandchildren
Member - Individual $225 / covers one person age 18 or older
Member - Tennis Only ($150)
Associate Member - Family ($445) (no initiation fee)
Associate Member - Couple ($375) (no initiation fee)
Associate Member - Individual ($325) (no initiation fee)
Associate Empty Nester with Grandchildren ($405) (no initiation fee)
Associate Empty Nester without Grandchildren ($335) (no initiation fee)
Associate Member - Tennis Only ($175) (no initiation fee)
I certify that if I selected Member (vs Associate Member), I am a 2016 SCA member or I have previously paid the $250 initiation fee
New Member Sign Up Bonus: 4 free guest passes + $10 snack bar credit included! (For members who have not joined the pool in the past 5+ years).
I certify that I have not been a member of Surreywood Swim Club for five years.
Guest, Sitter, and Child Care Passes
For a description of pass types, click:
Guest Pass (10 visits) $50
Sitter Pass (for your sitter) $75 each sitter
Child Care Pass (you are a sitter) $75 each child
Sponsored Swim Team Individual ($225)
Friends of the Pool Contribution
Submit a donation to the pool. (Donations of $40+ are invited to FOP appreciation party.)
Payment in full is required for active membership. If using an installment plan, add a $15 one time processing fee and make three equal payments due on 2/15, 3/15 and 4/15. *** Select request invoice or send in your membership payment via postal mail to PO Box 74303, North Chesterfield, VA 23225 or placed in Drop Box at 7753 Lake Forest Drive, N. Chesterfield, VA 23235
Cash - Full Balance
Check - Full Balance
On Line - Full Balance - Request Invoice
On Line - Payment Plan - Request Invoice
Cash - Payment Plan
Check - Payment Plan
If using and installment plan, please enter the installment payment amount:
Name(s) of Sitter, Child Care or Sponsored Individual
Member Names and Birthdates
Enter all members (including yourself) requiring access to the pool by name (One name per line)
Specify your physical residence address
Primary Phone Number
Enter your Home or Mobile Phone number and specify phone type
Specify phone number and type (mobile, home, etc)
Would you like to receive the pool newsletter?
How did you hear about us?
Flyer (Pull tag)
Are you interested in volunteering?
Pool fun activities or events
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