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This form is to be used by new members only! (If you are a current member and need a renewal form, please call Joe Mainey at (703) 256-5765

                                                    LINCOLNIA PARK RECREATIONAL CLUB, INC.

New Member Annual Dues Statement

2004 Season

 Dear New Member: Please take a moment to enter all of the information on this form. 

For definitions of each category, please refer to the LPRC MEMBERSHIP CATEGORIES AND 2004 FEE

SCHEDULE Checks should be made payable (and mailed) to: LPRC, P.O. BOX 243, ANNANDALE, VA 22003                                                                                                   

                                MEMBER INFORMATION                             CHILD'S NAME               DATE OF BIRTH

Member Name(s):

 

 

 

 

 

 

 Address:

 

 

 

 

 

 

 City, State, Zip:

 

 

 

 

 

 

 Telephone #:

 

 

E-mail:

 

 

 

 

 

 

 

 

 

 

 2004 Annual Fee Calculation - Check and insert corresponding dollar amount in the column to the right

 Basic Memberships:  (Check one)                             

       Basic Membership (2 persons living at the same residence) ($360)        

       Basic Membership + 1 dependent child         ($375)    

       Basic Membership  + 2 dependent children   ($390)           

___Basic Membership + 3 dependent children    ($405)

___Basic Membership + 4 dependent children   ($420)

       Basic Membership + 5 dependent children  ($435)

 

 

$           

 

 

               

Individual Member     $295

 Individual Member (shareholder)

$           

 Senior Individual         $215

 At least 60 years of age.

 

$           

 Senior Basic Members               $245

 2 senior members. Both must be 60+ years of age and residing at same address.

 

$           

 Seasonal Guests             $80

 $80 each X          

Enter Name(s) and relation to member:                                                                                                                                                                                                                                                                                          

 

$           

Guest Passes               $45

 10 for $45.  Enter number of books           X $45

 

$           

 

 WORK FEE $75

 $ 75 WORK FEE   (Waived for new members)

 

 

$    0       

 

 

Swim Team Fees

$50/child or $130 maximum for family
# of children participating in Swim Team______ Name(s):____________________________, _________________________
           

 

$          

 Junior Tennis Fees

 

Call Dawn or Richard Volk for  info at

658-5353

 # of children participating in Tennis Team______($25/child or $65 family maximum)

Name(s) for tennis team:________________________________________________

 # of JDP tennis weeks_______________($20/4day week)

Name(s) for JDP:______________________________________________

 

$          

Water Aerobics

256-0645

Classes meet 2 times per week for 60 minutes at no cost to adult members!

Circle 2 days you prefer:  Mon     Tues     Wed     Thurs   Fri    Sat    Sun

 

$  0

 

TOTAL DOLLAR AMOUNT DUE                                                                        $ ____