Swim Team Registration Form

BELAIR= Swim & RACQUET CLUB

Post Office Box 499

12728 Midwood Lane

Bowie, MD 20718

MEMBERSHIP APPLICATION

Date: __________________            = ;            &n= bsp;            = ;

Applicant’s Name*:_____________= _____________________________ Birthdate______________

Spouse’s Name: ____________________________________________ Birthdate______________<= o:p>

Present Address: ________________________________________________Zip______________<= o:p>

Home Phone #: (_____)__________________ = Work/Cell Phone #: (_____)___________________
E-mail Address: {Please print clearly below. BSR sends out News via e-mail}       *This will be last name used at the Gate= .

Chil= dren Living at Home (list additional on = back)        &= nbsp; Birth Date: (Month - Day -    Year    )

1. _____________________________________________________(_______-_____-_______= _)

2. _____________________________________________________(_______-_____-_______= _)

3. _____________________________________________________(_______-_____-_______= _)

4. _____________________________________________________(_______-_____-_______= _)

5. _____________________________________________________(_______-_____-_______= _)

6. ______________________________________________= _______(_______-_____-________)

Current Member Referring You to BSR (If Any):____________= __________________________

How did you hear a= bout BSR?

Circle One:= Friend -= Blade Ad - C= onsumer Advantage Ad - RT450 Signs - Yard Signs - Other
At the pool front gate we will take a passport-like photo of each family membe= r.

** All persons in the Family Unit must,= per the Club By-Laws, “permanently and continuously reside in the member’s household.”

I (We) agree to abide by the Rules and Regulations of the Belair Swim & Racquet Club, Inc. as documented in the Member’s Handbook. I (We) further understand that whi= le a member of the Club, I am (We are) responsible for any payment of the annual maintenance fee(s).

____________________________________        &= nbsp;

Applicant’s Si= gnature

            =             &nb= sp;            =             &nb= sp;

For Pool Use Only

&= nbsp;

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;           Date Received:______________________

For C= lub & Membership information visit: www.bsrbarracudas.com

Post Office Box 499

12728 Midwood Lane

Bowie, MD 20718

Applicant’s Name*:_= ___ Birthdate

Spouse’s Name: ______________________________ Birthdate<= o:p>

Present Address: __________________________________Zip<= o:p>

Home Phone #: (_)____________ = Work/Cell Phone #: (_)_________________
E-mail Address: {Please print clearly below. BSR sends out News via e-mail} *This will be last name used at the Gate= .

For Pool Use Only

Post Office Box 499

12728 Midwood Lane

Bowie, MD 20718

Applicant’s Name*:_____________= _____________________________ Birthdate______________

Spouse’s Name: ____________________________________________ Birthdate______________<= o:p>

Present Address: ________________________________________________Zip______________<= o:p>

Home Phone #: (_____)__________________ = Work/Cell Phone #: (_____)___________________ E-mail Address: {Please print clearly below. BSR sends out News via e-mail} *This will be last name used at the Gate= .

For Pool Use Only

Applicant’s Name*:_= ___ Birthdate

Spouse’s Name: ______________________________ Birthdate<= o:p>

Present Address: __________________________________Zip<= o:p>

Home Phone #: (_)____________ = Work/Cell Phone #: (_)_________________
E-mail Address: {Please print clearly below. BSR sends out News via e-mail} *This will be last name used at the Gate= .