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YWCA of Central Maine Membership Form
Gender
Male
Female
Birthday
Name
Address
Parent or Guardian Name (if under 18)
Home Phone
Cell Phone
E-Mail
Does this member have any conditions that we should be aware of, or that require special accomidations? (ex: Asthma, Autism, Seizures)
No
Yes
If yes, please specify
Emergency Contact Name, Number and Relationship to Member
Please specify who the membership you are purchasing is for
Adult 18-59 years
Senior 60+ years
Youth 13-17 years
Child 6months-12 years
Family - up to 2 adults and 4 children, same home
Please specify which membership you are purchasing
Basic
Open Swim
Water Fitness
Y-Wide
Please specify the length of membership you are purchasing *Basic memberships are annual memberships and are only available for 1 year purchases*
1 Month
3 Months
1 Year
Basic Membership ONLY - 1 year
