MAIL TO: Eldwick Swim & Tennis Club , 11324 Berger Terrace
Fall
08
N
Eldwick Swim & Tennis Club
Membership Application
2015
Name:
____________________________________________________________________________________________________________
Address:
__________________________________________________________________________________________________________
Home #:
__________________________
Cell #:
_________________________
(Adult1)
________________________
(Adult2)
Email: ____________________________________ (Adult1) __________________________________ (Adult2)
Adults Living in Household Children Living in Household Date of Birth (MM/DD/YY)
_____________________________ ________________________________ __________________________
_____________________________ ________________________________ __________________________
_____________________________ ________________________________ __________________________
_____________________________ ________________________________ ___________________________
MEMBERSHIP OPTIONS:
FAMILY MEMBERSHIP: $715
(PLEASE PAY PRIOR TO MAY 15)
_________________
Add: Initiation Fee Amount Due ($200/year for years 2 - 5) __________________
(Remaining balance prior to this year’s payment will be provided by separate email)
OR SUMMER MEMBERSHIP: $850 – short-term membership for families who do not plan to remain in neighborhood
OR FIRST YEAR INTRODUCTORY MEMBERSHIP: $475
OR SENIOR CITIZEN MEMBERSHIP: $350 – special annual rate for Eldwick
__________________
__________________ members 65 and over
PLUS OPTIONAL VOLUNTARY DONATION (If your family enjoys summers at Eldwick,
__________________ a voluntary donation of $50 or more is greatly appreciated.) __________________
TOTAL PAID to Eldwick Swim Club __________________
Medical Release Authorization:
I give my consent and approval to the Eldwick Swim and Tennis Club and employees or agents of their authorized pool management company to act on my behalf in securing emergency medical attention for the above individuals from a licensed hospital or physician.
_____________________________________________ ___________________
Signature Date
MAIL TO: Eldwick Swim & Tennis Club , 11324 Berger Terrace , Potomac MD 20854 703-887-7613
