Bainbridge Island Recreation Center: Individual 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

$86.19

$5.67

Service	Down Payment	Recurring	Rollover	Visits
Member 1
Basic Class	$0.00	$0.00	$0.00	0
Individual Monthly Dues	$0.00	$79.00	$0.00	0
Prorated Dues	$5.20			0
Sub-Total	$5.20	$79.00
Tax	$0.47	$7.19
Total	$5.67	$86.19

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

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