MEADOWBROOK SWIM CLUB

8301 Corbett Road

PO BOX 135
Pennsauken NJ 08109
856-665-9109
www.meadowbrookswimclub.net
MEMBERSHIP APPLICATION
LAST NAME _______________________________FIRST _________________
NAME OF
SPOUSE_______________________________________________________
STREET
ADDRESS:______________________________________________________
CITY_____________________________STATE______ZIP________________
HOME PHONE (

) ___________________CELL PHONE(

) ____________

EMERGENCY PHONE /CONTACT ___________________________________

EMAIL ADDRESS: ________________________________________________
Name of those listed on Membership and relationship
(only those listed will be permitted entrance)
1)

DOB

2)
3)
4)
5)
How did you hear about Meadowbrook ?______________________________
The undersigned applies for Membership to the Meadowbrook Swim Club
and agrees to pay the annual dues for membership and to abide by the
rules set forth by the Club.
SIGNATURE
________________________________________________DATE______