Bainbridge Island Recreation Center: Senior Couple Non-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

$154.92

$458.68

Service	Down Payment	Recurring	Rollover	Visits
Member 1
Basic Class	$0.00	$0.00	$0.00	0
Couples Monthly Dues	$299.00	$142.00	$0.00	0
Prorated Dues	$121.42			0
Sub-Total	$420.42	$142.00
Tax	$38.26	$12.92
Total	$458.68	$154.92

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

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