Group Child Pass Registration - PMPA

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GROUP CHILD MEMBERSHIP REGISTRATION

Group Child pass- Register online here (payment required on next screen)

* Indicates required field

Last Name (person receiving pass) *

Phone # (person receiving pass) *

Email (person receiving pass) *

Address (person receiving pass) *

Line 1

Line 2

City

State

Zip Code

Country

Child 1 for pass *

First

Last

Birthday of Child 1 *

Include Swimming Lessons ($10 paid on next screen) *

YES NO

Child 2 for pass *

First

Last

Birthday of Child 2 *

Include Swimming Lessons ($10 paid on next screen) *

YES NO

Child 3 for pass *

First

Last

Birthday of Child 3 *

Include Swimming Lessons ($10 paid on next screen) *

YES NO

Child 4 for pass *

First

Last

Birthday of Child 4 *

Include Swimming Lessons ($10 paid on next screen) *

YES NO

Child 5 for pass *

First

Last

Birthday of Child 5 *

Include Swimming Lessons ($10 paid on next screen) *

YES NO

Child 6 for pass *

First

Last

Birthday of Child 6 *

Include Swimming Lessons ($10 paid on next screen) *

YES NO

Child 7 for pass *

First

Last

Birthday of Child 7 *

Include Swimming Lessons ($10 paid on next screen) *

YES NO

Comment *

Name of person purchasing pass (if different than above) *

First

Last

Email (if different than above) *

Phone # (if different than above) *

By pushing submit, you agree to make your payment on the next screen. Otherwise, please print and mail the application with your payment.

Submit & Next

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