Cary Swim Club			www.caryswimclub.org
	PO Box 483, Cary NC 27512-0483			919.469.8084
Membership Application
Last Name		Home Phone
Street
City		Zip Code
Emails
	Member Name	Birth Date	Swim Team?	Swim Lessons?
Adult
Adult
Youth
Youth
Youth
Youth
Please note any interests or activities you would like to enjoy at Cary Swim Club
Fees	Number of Members (one MUST be an Adult)	3 +	2	1 Adult
	Application Fee	$25	$25	$25
	Initiation Fee	$200	$200	$200
	One-time, Non-refundable Fees Subtotal	$225	$225	$225
	2008 Annual Dues	$405	$324	$165
	Total	$630	$549	$390
Amount Enclosed	$	Check Number
Mastercard or VISA		Expiration Date
Card Number
Cardholder Signature		Amount Authorized	$
Please complete this form and mail with payment to:
	Cary Swim Club Treasurer, PO Box 483, Cary NC 27512-0483
Applications and Payment are also accepted at the pool during normal operating hours.
	536 Walnut Street (corner of Walnut & Tanglewood)
	We were referred to Cary Swim Club by