2011 MEMBERSHIPS APPLICATION

FAMILY MEMBERSHIP
$205 -- before January 1
$225 -- starting January 1
 		INDIVIDUAL MEMBERSHIP
$110 -- before January 1
$130 -- starting January 1

Senior Membership (62 and older) -- $75

For more information call 838-1122
MEMBERSHIP APPLICATION

I hearby apply for membership in the Palmyra Community Pool and agree to comply with the pool rules and regulations.

NAME________________________________PHONE_____________

ADDRESS________________________________________________

Please circle desired plan:    F    I    S       Amt________________

Additional tax free deduction:   $25   $10   $5   other _______________
NO._____________
(Pool use only)

Additional family members:

Name                            Age
_________________   _____
_________________   _____
_________________   _____
_________________   _____
_________________   _____
_________________   _____
_________________   _____

Family plan membership consists of Head of household, spouse, children under the age of 18 or students residing at the same address, high school students who will or did graduate this membership year and college students can be added as well.

If you would like your passes before opening day or for a gift, please send a self addressed stamped envelope and the passes will be mailed back to you.

MAIL TO: PALMYRA COMMUNITY SWIMMING POOL | P.O. BOX 325 | PALMYRA, PA 17078