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SJAC Non-Member Annual Fee

$75

SJAC Swim School Annual Fee

$75/year

The annual facility usage fee is for SJAC Swim School lesson participants who do not enroll for an NL Aquatic Center membership. Non-members can still sign up for programs but do not receive the discounted member pricing and do not have access to open lap swim before or after their scheduled lesson with SJAC Swim School.

MEMBER INFORMATION

First Name

Last Name

E-mail Address

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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

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
One Time Payments:
SJAC Swim School Annual Fee	$75.00
Amount due now:	$75.00

SJAC Swim School Annual Fee

$75/year

MEMBER 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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