Edgebrook Swim and Tennis Club
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equity membership
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Primary Member's Name
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First
Last
Secondary Member's Name
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First
Last
Primary Member (Choose One)
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Secondary Member (Choose One)
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Male
Female
Other
Primary Member's Full Birthdate
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Secondary Member's Full Birthdate
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Primary Member's Email
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Secondary Member's Email
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Primary Member's Home Phone
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Secondary Member's Home Phone
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Primary Member's Cell Phone
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USTA Rating
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2.5
3.0
3.5
4.0
4.5
5.0
N/A
Secondary Member's Cell Phone
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USTA Rating
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2.5
3.0
3.5
4.0
4.5
5.0
N/A
Address
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Line 1
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City
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(Child #1) Full Name
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(Child #1) Full Date of Birth
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(Child #1) Please Select
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(Child #2) Full Name
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(Child #2) Full Date of Birth
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(Child #2) Choose One
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Additional Children's Full Name, Date of Birth & Gender
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I would like my account to be set up for autopay
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Yes - I agree to have my statement balance auto charged on the 20th of each month
No - Do not auto charge. I agree to submit payment for my bill monthly
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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