The  Elks Swim Club

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 ELKS SWIM CLUB INC.

NEW MEMBER APPLICATION FORM

                                                Last                                                     First

 Your Name                 ___________________________      ______________________

 Spouse’s Name          ___________________________      ______________________

 Street Name               ____________________________________________________

 City                             __________________  State & Zip Code     ________________

 Home Phone No.        __________________  Work Phone No.      ________________

 E-mail Address           ________________________                                   

  Return this Form with the 2010 Membership Annual Dues Form

ONE-TIME-ONLY, NON-REFUNDABLE NEW APPLICANT FEE :  $75.00

PLEASE RETURN THIS FORM WITH A $75.00 CHECK MADE PAYABLE TO

“ELKS SWIM CLUB, INC.”

POOL OPENS SATURDAY, MAY 29, 2010