10316 Boxelder Drive, Raleigh, NC 27613

Membership Application - New or Renewal

Wood Valley Swim and Racquet Club
Application for Membership

Applicant Information Co-Applicant Information (Spouse)
Name:
Address:
City, State, Zip:
Subdivision:
Home Phone:
Email:
Profession:
Company:
Work Phone:
Name:
Email:
Profession:
Company:
Work Phone:
Family Information
Child’s Name:
Child’s Name:
Child’s Name:
Child’s Name:
Child’s Name:
Child’s Name:
Child’s Name:
Birthday:
Birthday:
Birthday:
Birthday:
Birthday:
Birthday:
Birthday:
Allergies or Health Problems
Item 1
Item 2
Emergency Contacts (for lifeguard use)
Name 1)
Name 2)
Phone No.
Phone No.
Dues
Optionally purchase stock:
$ 500.00 one time payment or pay in installments - Year 1 $ 200.00, Year 2 $ 200.00,Year 3 $ 100.00

No stock purchase: $ 0.00
Full stock purchase: $ 500.00
Year 1&2 stock installment: $ 200.00
Year 3 stock installment: $ 100.00

Dues:
Stockholding Member dues: $ 465.00
Annual Member dues: $ 590.00
Stockholding Member Empty Nester dues: $ 335.00

New member discount:
New member discount: $ 100.00

Payment Method

Check the box to indicate how you would like to pay


  		Pay Online (PayPal or Credit Card)
Note: An additional charge of $ 10.00 will be added to cover costs associated with online payment