club use only do not write in this space

M/S NAME: _____________________________________________ M/S #:________________________________

FoxChasePhil - Please Print This Form and MailFCSC Please Print This Form and Mail
 

please print
LAST NAME:

FIRST NAME :

HOME PHONE:______________________________

WORKPHONE:______________________________

CELL PHONE:_______________________________

EMERGENCY PHONE:____________________________________

SPOUSE'S FULL NAME :

HOME PHONE:______________________________

WORKPHONE:______________________________

CELL PHONE:_______________________________

EMERGENCY PHONE:____________________________________

  1. This is your FAMILY'S MEMBERSHIP FORM, NO MEMBERSHIP CARDS WILL BE ISSUED...
     please return this form as soon as possible!
  2. In order to process your membership, we require individual wallet size, head shots of each person on the membership.
  3. If you do not have any reasonable photographs of members we can use, come to the FOX CHASE SWIM CLUB after we open for the season and we will take pictures of the members at a cost of $5.00 per Family!

INDIVIDUAL HEAD SHOTS FOR EACH MEMBER incldn'g GRANDPARENTS
           

___________
Name:
___________
Age:

___________
Name:
___________
Age:

___________
Name:
___________
Age: 		___________
Name:
___________
Age: 		___________
Name:
___________
Age: 		___________
Name:
___________
Age:

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©2010 FOX CHASE SWIM CLUB
mail forms to: FOX CHASE SWIM CLUB, PO BOX 94, CHELTENHAM , PA 19012
e-mail to: - foxchasefamily@comcast.net • phone: - 215-725-8187
Fox Chase Swim Club, 1098 Solly Ave. Philadelphia PA 19111, 1 block E. of Rhawn & Verree
open MEMORIAL DAY, weekends only until June 15, then everyday until LABOR DAY!
HOURS 11:00AM to 8:00PM / AUGUST HOURS - 11:00AM to 7:00PM!
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