(Please fill in form on computer, print and mail with application)
Bondholder Name
Address City State Zip
Home Phone Cell Phone
____________________________________________________________________________________________
Names of (2) Recommending current LPSC Members Phone Number
(inform member we may be contacting them)
Check if you are new to the area, or do not know any members of Lawrence Park Swim Club.
If a current Lawrence Park Swim Club member has reffered you to join, please let us know. They are eligible for a free guest pass book.
Name of Member
Membership includes family members consisting of the bondholder, his/her spouse, and their children living at home. The family member must be residing in the same residence to be eligible for membership.
Name(s) of Member(s) Date of Birth and Relationship
(Spouse, Child, Daycare)
Fees Enclosed with Application:
Application Fee
Bond Fee
Membership Fee
CIF Fee
Total Amount
Check #
Approved________________________________
Membership Chairman Date____________