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Family Membership Order Form
Primary Applicant
Email Address
(Required)
Phone Number
(Required)
First Name
(Required)
Last Name
(Required)
Date of Birth
(Required)
MM slash DD slash YYYY
Address
(Required)
City
(Required)
Province
(Required)
Postal Code
(Required)
Country
(Required)
Membership Details
For all applicable, please enter the full name & date of birth your spouse/partner & dependants ( children aged 18 yrs of younger). All family members must reside in same household.
(Spouse / Partner) First Name
(Spouse / Partner) Last Name
(Spouse / Partner) Birth Date
MM slash DD slash YYYY
Child 1 First Name
Child 1 Last Name
Child 1 Birth Date
MM slash DD slash YYYY
Child 2 First Name
Child 2 Last Name
Child 2 Birth Date
MM slash DD slash YYYY
Child 3 First Name
Child 3 Last Name
Child 3 Birth Date
MM slash DD slash YYYY
Child 4 First Name
Child 4 Last Name
Child 4 Birth Date
MM slash DD slash YYYY
Child 5 First Name
Child 5 Last Name
Child 5 Birth Date
MM slash DD slash YYYY
Payment Details
Family Membership
Price:
Total Purchase Amount*
Membership is valid from date of purchase to end of calendar year.
All orders are processed securely through the Square payment method, ensuring a smooth and safe transaction experience. Rest assured that your payment information is protected throughout the entire purchasing process.
Credit Card Details
(Required)
Cardholder Name
Card Details
Membership Unique Identifier
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