SUMMER  APPLICATION   VALLEYCREST  2000   INSCRIPTION D’ÉTÉ
 Family / Famille                             Couple                         Single Adult(e) Seul                 Adolescent(e)      AGE
  p$220                                    p$175                              p$130                              p$120

 
Family Name   _______________________________________________________ GENERAL MEM. # ___________
Nom de Famille                                                                                                 MEM. GÉNÉRAL #

Home E-Mail ___________________________________________________________________________________
  Résidentiel

Address____________________________________________________   City _______________________________
Adresse                                                                                              Ville

Postal Code_______________________________    Tel. #    (________) ___________________________________
Code Postal                                                        # de Tél.

                All members on this form must reside at the above address / Tous les membres ci-nommés doivent résider à l’adresse ci-dessus

2nd  Adult  ________________________________________   Child _______________________________________
2e Adulte                                                                            Enfant                                                            AGE
 

Child____________________________________________   Child ________________________________________
Enfant                                                                  AGE     Enfant                                                             AGE

Child____________________________________________   Child ________________________________________
Enfant                                                                  AGE     Enfant                                                              AGE
 

Other Family Member  ____________________________________________________________________________
Autre Membre de la Famille                                                                                  Relationship /  Lien de parenté
 

Babysitter ______________________________________________________________________________________
Gardienne                                                                                                                                                 AGE
 
INSCRIPTION GENERAL MEMBERSHIP ____________________________________________     $_________
 

GUEST CARD  /  CARTE D’INVITÉ - ____________________________________ $20 X ______ =  $_________

 
                                                                                                                                 TOTAL:  $_________
  Cash            Cheque to:
 p      p   Club de Natation VALLEYCREST Swimming Club
Comptant       Chèque à:
                                                                                                                         Att. Lydie Bernard
INFO: 514-620-1755     or/ou     mjeanr@sympatico.ca                                          17589 Clermont
www.geocities.com/Baja/Cliffs/7407/valleycrest.html                                               Pfds.,  H9J 1C4