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:
Cell Phone:
Name:
Email:
Profession:
Company:
Cell 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.
Volunteer Opportunities
I am interested in volunteering in the following areas. Please indicate your interest - areas that need help are Youth Sports, Kids’ Socials, Adult Socials, Maintenance, Clean-up Days, Other (please specify)

I will help:
I will help:
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: $ 515.00
Annual Member dues: $ 655.00
Stockholding Member Empty Nester dues: $ 370.00

New member discount:
New member discount: $ 100.00

Submitting your application indicates that you believe the above information is correct and accurate to the best of your knowledge, and that you have read and agree to the WV Rules . WVS&RC agrees not to share information with anyone outside of the organization.
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