Community Center : Membership Agreement - Home for the Holidays

Membership Agreement - Home for the Holidays 

Please fill out the following form to register for a Home for the Holidays membership at the Brushy Creek Community Center.  Once you click the submit button below, your request will be sent to Customer Service who will contact you within one business day to collect payment information.

MEMBER INFORMATION:         
   Last Name:    First Name:    M.I.:   
   Street Address:    City:    Zip:   
   Home Phone:    Cell Phone:    DOB:   
   Email Address:    Allergies:    Sex:  M F  
   Would you like to receive information from the Community Center via email? Yes No  
EMPLOYER INFORMATION:         
   Employer:    Work Phone:       
 
EMERGENCY INFORMATION:         
   Name:    Phone:    Relation:  
   Name:     Phone:    Relation:  
         
MEMBERSHIP AND PRICING OPTIONS:   
   Home for the Holidays:    1-Month Term **
      Resident Individual   $25
      Non-Resident Individual  N/A

CONTRACT TERMS: