Bainbridge Island Recreation Center: Family Resident

This plan requires 2 members with a maximum of 10 members.

How many total members would you like on this plan?

* This plan requires a minimum number of members including the primary member.

(1) Primary Member Information

First Name

M.I.

Last Name

Address 1

Address 2

City

State / Province

Zip / Postal Code

Home Phone

Mobile Phone

OK to Contact Home Phone

OK to Contact Mobile Phone

Preferred Phone

Home

Mobile

OK to Contact Email?

Birth Date

$204.02

$187.87

Service	Down Payment	Recurring	Rollover	Visits
Member 1
Basic Class	$0.00	$0.00	$0.00	0
Family Monthly Dues	$0.00	$187.00	$0.00	0
Prorated Dues	$172.20			0
Sub-Total	$172.20	$187.00
Tax	$15.67	$17.02
Total	$187.87	$204.02

Payments will then be processed on a Monthly basis there after.

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