2012 RW Green Book Forms-1 - Ridgewood Pool
2012 RW Green Book Forms-1 - Ridgewood Pool
2012 RW Green Book Forms-1 - Ridgewood Pool
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<strong>2012</strong> <strong>Ridgewood</strong> <strong>Pool</strong> Membership Registration Form<br />
Required Member Information:<br />
Name (both Parents if Applicable)_____________________________________________________ Phone _______________________<br />
Address _____________________________________________ City____________________________________ Zip _______________________<br />
Email _____________________________________________________________________________________________________________________<br />
Required Membership Dues & Fees: Please write the correct amount in the right-hand column, and Add/Subtract to<br />
calculate your Summer <strong>2012</strong> total. (The price on left is Full Price (Credit Card), the price on right* is the Cash/Check discount price.)<br />
Fee Category<br />
Full Price/Cash-<br />
Check Price<br />
CURRENT STOCKHOLDERS (or Purchasing Stock Below). Choose one<br />
of the Following Four:<br />
Family Plus or Family Plus Team Membership Dues $615/$595* $<br />
Family Rec Membership Dues $545/$525* $<br />
Couple Membership Dues $340/$325* $<br />
Individual Membership Dues<br />
2011 SUMMER NON-STOCK MEMBER DISCOUNT – Must Own or<br />
$260/$250* $<br />
Buy Stock or Installment Plan (Discount also applies for 2009 Summer Non-‐<br />
Stock Members who did not buy stock in 2010.)<br />
Choose One of the Following Three:<br />
Subtract $200 $<br />
I wish to purchase <strong>Ridgewood</strong> <strong>Pool</strong> Stock (full payment) $550 $<br />
I wish to make my ___1 st, ___2 nd or ____3 rd Stock Installment payment $200 $<br />
I have already purchased <strong>Ridgewood</strong> <strong>Pool</strong> Stock $0 $<br />
SWIM/DIVE TEAM FEES (Transfer amount calculated on Swim/Dive Team form)<br />
STROKE CLINIC REGISTRATION FEES (Transfer amount from Stroke Clinic form)<br />
<strong>2012</strong> NON-STOCK SUMMER MEMBERSHIP – New Members only<br />
(to be eligible you may not have ever owned <strong>RW</strong> Stock or previously<br />
purchased a Non-‐Stock Summer Membership)<br />
DONATION – I wish to donate this amount to <strong>Ridgewood</strong> for this purpose:<br />
___Swim Team ___Dive Team ___Bldg & Grounds ___Best Use<br />
$410/$395* $<br />
Donation $<br />
Write Correct<br />
Amount<br />
TOTAL OF ALL FEES $<br />
PAYMENT - CHECK ONE: ___ A check payable to “<strong>Ridgewood</strong> <strong>Pool</strong> Inc. is enclosed ____ I will pay via Credit<br />
Card at www.ridgewoodpool.com<br />
Required Membership Signature: I understand that I am obligated to meet the Member Service Requirement described in the<br />
<strong>2012</strong> <strong>Green</strong> <strong>Book</strong>, and if I do not I agree that I will pay the $50 Member Obligation Fee when billed after the <strong>2012</strong> Season.<br />
Signed: ____________________________________________________________________________ Date: ___________________________<br />
Please send all forms and pay all fees to:<br />
<strong>Ridgewood</strong> <strong>Pool</strong> Membership c/o Becky Jenn<br />
5117 Flad Avenue, Madison, WI 53711<br />
REGISTER ONLINE AT<br />
RIDGEWOODPOOL.COM<br />
Upon receipt of fee payment your<br />
complimentary Guest Passes will be issued<br />
and made available for pick-‐up at the pool.<br />
If you were Referred by another member, please write the family’s name (one name only please) – _______________________<br />
You must fill out Emergency Medical Treatment Release Form for all children younger than 18.
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