Name: Address: Address Line 2: City: State: Zip Code:	E-Mail:
Phone: Cell Phone (Optional): Fax: (May be a work FAX if you can receive BCAS faxes there)	Primary Interest: If Other, Please Indicate:
How did you hear about us? Name of Referring Member (If Applicable): Specify if "Other" Selected:	Would you be willing to volunteer for activities (i.e.: Helping at the barbecue, Sunshine Committee, etc...)? Yes No Would you like your name published in the "Membership Directory"? Yes No If "Yes", please select the information you would like listed other than your name and aquatic interests (Un-check any that you do not want): Address Phone # E-Mail
Please include any other information you would like included in the directory:
Other family members, if Family Membership (Please separate names with commas):

Membership Registration

All Memberships:
$20.00 for 1st member of household
$10.00 for each additional household member
Entering your information here will only forward it to our Membership Chair
To make payment on your membership, please bring payment to a meeting