UCSC
Application for Membership
Summer 2005
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Father’s/Guardian’s First and Last Name
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Mother’s/Guardian’s First and Last Name |
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Home Address |
Home Address
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City State Zip |
City State Zip
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Home Phone |
Home Phone
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Business Phone |
Business Phone
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Cellular/Pager |
Cellular/Pager
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E-mail Address |
E-mail Address
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Swimmer(s) Enrolling
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Child’s Name |
Age |
Gender |
Birthdate |
School |
Group |
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Registration Fees Summer 2005 |
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Team |
Training Fee per Month |
USA Dues (mandatory) |
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SuperSwimmer |
$40 |
$46 |
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AGD |
$50 |
$46 |
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Senior |
$50 |
$46 |
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High School Prep (HSP) |
$50 |
$46 |
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Masters |
$40 |
Swimmer’s responsibility |
Please read the following information thoroughly and initial below.