BRIAR-QUEEN RECREATION ASSOCIATION
I N C O R P O R A T E D
PO Box 9168, Hampton, Virginia 23670
Phone 826-7868
| Check Type of Membership | Rate |
|---|---|
| Family | ___$250.00 |
| Couple | ___$205.00 |
| Single(min. age 18) | ___$175.00 |
Attached is my membership dues for the amount of $____________for the 2001 season (year)
| Mailing Address: | Name_____________________________ | Home Phone_________________ |
| Address____________________________ | Work Phone__________________ | |
| City___________________________ | Zip Code_______________ |
Please list all members of your household who are eligible for membership privileges:
| Adults | Children's names and date of birth |
|---|---|
| ____________________ | ___________________________________ |
| _____________________ | ___________________________________ |
| _____________________ | ___________________________________ |
Please provide with your application either a recent composite or individual photographs of your family
members so that this information can be attached to your gate card for easy identification. All photos
will be copied and the originals returned to you. (wallet size would be ideal)
Signature of Applicant__________________________________________
Signature of Sponsoring Member___________________________________
I am interested in helping with the following committees:
___Telephone Commitee ___Gatekeeping ___Concessions ___Swim Team
___Socials ___Buildings & Grounds ___Other(list)_______________________
Partial payment of membership dues accepted prior to opening day, however, as of that date
dues must be paid in full for admittance to the pool.
