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SJAC Fam Mem (Multi-Child)

$35 / month (multi-child)

SJAC Family Membership

$35/month (multi-child)

Families participating in SJAC programs are eligible for this special rate.

This includes SJAC Swim School, competitive and

non-competitive swim teams and water polo.

Membership also receive a 10% discount on lessons!

MEMBER INFORMATION

First Name

Last Name

E-mail Address

Verify E-mail

Birthday

Gender

Street Address

City

State

Zip/Postal Code

How did you hear about us

Home Phone

Work Phone

Cell Phone

Employer

Emergency Contact

Emergency Phone

Silver Sneakers

Original Member ID

Family Member Names

Family Information

First Name

Last Name

E-mail Address

Verify E-mail

Birthday

Gender

Same address as primary member

Street Address

City

State

Zip/Postal Code

Same phone information as primary member

At which phone would you prefer to be contacted?

Home Phone

Work Phone

Cell Phone

Family Information

First Name

Last Name

E-mail Address

Verify E-mail

Birthday

Gender

Same address as primary member

Street Address

City

State

Zip/Postal Code

Same phone information as primary member

At which phone would you prefer to be contacted?

Home Phone

Work Phone

Cell Phone

Family Information

First Name

Last Name

E-mail Address

Verify E-mail

Birthday

Gender

Same address as primary member

Street Address

City

State

Zip/Postal Code

Same phone information as primary member

At which phone would you prefer to be contacted?

Home Phone

Work Phone

Cell Phone

Family Information

First Name

Last Name

E-mail Address

Verify E-mail

Birthday

Gender

Same address as primary member

Street Address

City

State

Zip/Postal Code

Same phone information as primary member

At which phone would you prefer to be contacted?

Home Phone

Work Phone

Cell Phone

Family Information

First Name

Last Name

E-mail Address

Verify E-mail

Birthday

Gender

Same address as primary member

Street Address

City

State

Zip/Postal Code

Same phone information as primary member

At which phone would you prefer to be contacted?

Home Phone

Work Phone

Cell Phone

Family Information

First Name

Last Name

E-mail Address

Verify E-mail

Birthday

Gender

Same address as primary member

Street Address

City

State

Zip/Postal Code

Same phone information as primary member

At which phone would you prefer to be contacted?

Home Phone

Work Phone

Cell Phone

Family Information

First Name

Last Name

E-mail Address

Verify E-mail

Birthday

Gender

Same address as primary member

Street Address

City

State

Zip/Postal Code

Same phone information as primary member

At which phone would you prefer to be contacted?

Home Phone

Work Phone

Cell Phone

Family Information

First Name

Last Name

E-mail Address

Verify E-mail

Birthday

Gender

Same address as primary member

Street Address

City

State

Zip/Postal Code

Same phone information as primary member

At which phone would you prefer to be contacted?

Home Phone

Work Phone

Cell Phone

Family Information

First Name

Last Name

E-mail Address

Verify E-mail

Birthday

Gender

Same address as primary member

Street Address

City

State

Zip/Postal Code

Same phone information as primary member

At which phone would you prefer to be contacted?

Home Phone

Work Phone

Cell Phone

Family Information

First Name

Last Name

E-mail Address

Verify E-mail

Birthday

Gender

Same address as primary member

Street Address

City

State

Zip/Postal Code

Same phone information as primary member

At which phone would you prefer to be contacted?

Home Phone

Work Phone

Cell Phone

One Time Payments Billing Information

Method of payment

Account Number

Bank Routing Number

What's this?

Card Number

(no dashes or spaces)

Expiration Date

Name on Account

Security Code

What's this?

Use the same address information as above

Street Address

City

State

Zip/Postal Code

Recurring Billing Information

Use the same billing information as above

Method of payment

Account Number

Bank Routing Number

What's this?

Branch Number

What's this?

Financial Inst. Number

What's this?

Card Number

(no dashes or spaces)

Expiration Date

Name on Account

Use the same address information as above

Street Address

City

State

Zip/Postal Code

Membership Breakdown
Monthly Payments Starting on Oct 1, 2019:
SJAC Family Membership (Multi Ch	$35.00
Total	$35.00

One Time Payments:
SJAC Family Membership (1st mo.)	$35.00
Amount due now:	$35.00

SJAC Family Membership

$35/month (multi-child)

MEMBER INFORMATION

Family Information

Family Information

Family Information

Family Information

Family Information

Family Information

Family Information

Family Information

Family Information

Family Information

One Time Payments Billing Information

Recurring Billing Information

Membership Breakdown

Where is the Security Code?

Where is the Routing Number?

Where is the financial institution and branch number?

Where is the financial institution and branch number?

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