Bainbridge Island Recreation Center: Senior Resident

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

Monthly Payment

$60.01

$49.37

Service	Down Payment	Recurring	Rollover	Visits
Member 1
Basic Class	$0.00	$0.00	$0.00	0
Senior Monthly Dues	$0.00	$55.00	$0.00	0
Senior Monthly Dues	$45.25			0
Sub-Total	$45.25	$55.00
Tax	$4.12	$5.01
Total	$49.37	$60.01

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

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