Annual Dues Statement/Membership
Verification, 2005 Season
Please take a moment to check and correct
your family information on this form.
Please mail checks on or before
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MEMBER(S) INFORMATION CHILD'S
NAME DATE OF
BIRTH |
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Member Name(s): |
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Address: |
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City, State, Zip: |
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Telephone #: |
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E-mail: |
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2004 Annual Fee
Calculation (definitions on reverse) - Check one and insert corresponding
dollar amount in the column to the right. |
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Basic Membership: (Check one) Basic Membership (2 persons) ($360) Basic Membership + 3 dependent
children ($405) Basic Membership + 1 dependent child
($375) Basic Membership + 4
dependent children ($420) Basic Membership + 2 dependent children ($390)
Basic Membership + 5 dependent children
($435) |
$ |
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Individual Member $295 |
Individual Member |
$ |
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Senior Individual $215 |
At least 60 years of
age |
$ |
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Senior Basic Memb. $245 |
2 Senior members, Both
60+ years old, residing at same
address |
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Inactive Fee $110 |
Due on or before |
$ |
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Late Fee $50 |
For Active fee
postmarked after |
$ |
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Seasonal Guests $80 |
$80 each….Enter
Name(s) and relation to member: _________________________ |
$ |
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Guest
Passes $45 |
Earn 10 free guest
passes by getting a new member to sign up. 10 for
$45. Enter number of books X $45 (Passes at the gate will be $5) |
$
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WORK
FEE $75 (waived for 1st
year members) |
Work fee
applies to all active members (if
you intend to work off your work fees, please include a separate check for
$75, which will be returned or destroyed upon completion of work hours) Please
circle interest(s): clean-up/work
parties, engineering, membership, social programs, newsletter, swim program, tennis program, other:
________________________________ |
$ |
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SWIM Team Fees |
# of children
participating in swim team ($50/child
or $130 family maximum) Child's
Name:_____________________ Swim Child's
Name:_____________________ Swim Child's
Name:_____________________ Swim Child's
Name:_____________________ Swim |
$ |
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JUNIOR
TENNIS Team Fees DEVELOPMENT
PROGRAM (JDP) (see
reverse side for description) |
TENNIS
TEAM: # of children participating in team______($25/child or $65 family
maximum) Name(s)
of Children for TENNIS TEAM:____________________________________________ Refer to
the newsletter for fees & schedules. Updates to these are posted at: lprc.tripod.com JUNIOR
DEVELOPMENT PROGRAM (JDP): ($20 per 4
day week per child or special rate of $125 for 7 weeks if paid with dues
or by May 23rd. Name
& # of Weeks:______________________
Name & # of Weeks ______________________ Name
& # of Weeks:______________________
Name & # of Weeks______________________ |
$ $ |
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TOTAL
DOLLAR AMOUNT DUE |
$ |
Interested
in Water Aerobics? (Circle 2 days which
you would like to have a session): MON TUES WED
THURS FRI SAT SUN
Are you
willing to help save money and receive your newsletters via email? Yes/No
What can
we do to improve our facility for you and/or potential members?