Picket Post Swim & Tennis Club
2016 Pool, Tennis Member Invoice
P.O. Box 1715, Southeastern, PA 19399-1715
610-644-4646
Fax 610-725-1991
Email: picketpostsc@aol.com Website: www.picketpost.org
2016 Pool, Tennis Member Invoice
Individuals in Household
Membership Fee Schedule
NAME:
ADDRESS:
Single Adult Membership
Family Membership
Senior (62 or over)
Senior Family Membership
PHONE:
Discounted
Rate
If paid by
3/31/16*
If paid after
3/31/16*
$600
$900
$500
$800
$650
$950
$550
$850
CLUB DIRECTORY YES___ NO ___ TENNIS SUB ______
EMAIL ADDRESS: _________________________________________________
Were you referred by someone? If so, who?______________________________


New Additions to Household Membership require Proof of Residence.
Additions under 21 years of age as of April 1, 2016 must provide Date of Birth, and a photo ID.
PAYPAL NOW ACCEPTED ON THE WEBSITE, www.picketpost.org for more details.
* To qualify for the discounted rates, your remittance must be postmarked by March 31, 2016 or hand-delivered to
the office by that date.
Name of Each Member
(Please Print)
(Head of Household)
Indicate Adult/Child/Senior
Child’s Age
as of April 1, 2016
Membership Fee:
Refer to fee schedule
(Please circle )
Adult/Child/Senior
Adult/Child/Senior
Adult/Child/Senior
Adult/Child/Senior
Adult/Child/Senior
Adult/Child/Senior
Total Membership Fees
Guest Pass Card – 10 visits for $60.00-Good For Current Season Only
Enter # of tennis keys (eff. 4/1/16) at $10.00 each
x $10.00=
“Help the Club” Donation
Total Amount Enclosed
Renewal stickers will be applied to your membership card. Please 1) mail your card(s) with your payment or 2)
contact the office to make other arrangements. If you do not have your card, please send or bring to the office a photo
(1” x 1”) of each member. Validated cards will be returned to you. Please provide a self-addressed, stamped envelope.
ALL MEMBERS MUST PRESENT MEMBERSHIP CARDS PRIOR TO USING THE CLUB’S TENNIS AND
SWIMMING FACILITIES.
Please Return This Sheet With Your Payment.
For Office Use Only: Check #
Date of Receipt:
Number of Members: