MEMBERSHIP

equity Memberships

equity membership

* Indicates required field

Primary Member's Name *

First

Last

Secondary Member's Name *

First

Last

Primary Member (Choose One) *

Secondary Member (Choose One) *

Primary Member's Full Birthdate *

Secondary Member's Full Birthdate *

Primary Member's Email *

Secondary Member's Email *

Primary Member's Home Phone *

Secondary Member's Home Phone *

Primary Member's Cell Phone *

USTA Rating *

Secondary Member's Cell Phone *

USTA Rating *

Address *

Line 1

Line 2

City

State

Zip Code

Country

(Child #1) Full Name *

(Child #1) Full Date of Birth *

(Child #1) Please Select *

(Child #2) Full Name *

(Child #2) Full Date of Birth *

(Child #2) Choose One *

Additional Children's Full Name, Date of Birth & Gender *

I would like my account to be set up for autopay *

LIABILITY AND MEDICAL RELEASE: I assume full responsibility for myself, my family and my guests for any and all injuries, losses, or damages which might occur while on the Edgebrook premises; and to HOLD HARMLESS EDGEBROOK, ITS OWNERS, OFFICERS, AND EMPLOYEES FROM ANY LIABILITY WHATSOEVER FOR INJURIES, LOSSES, OR DAMAGES. In the event of a medical emergency involving myself or my family, I give consent to Edgebrook to provide first aid, and I grant permission to any duly licensed medical personnel and/or medical facility to provide medical care and/or emergency surgery WITHOUT INCURRING ANY LIABILITY. I acknowledge that I have read, understood, and accepted the conditions of this liability release. *

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