POOL/TENNIS SUMMER MEMBERSHIP

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The Lalla and Max B. Arnstein Jewish Community Center Association, Inc. of Knoxville A Division of the Knoxville Jewish Alliance, Inc. 6800 Deane Hill Drive, Knoxville, TN 37919 Phone: 865/690-6343 Fax: 865/694-4861 Website: www.jewishknoxville.org

POOL/TENNIS SUMMER MEMBERSHIP Primary Applicant Name

Spouse/Partner Name

Address State

City ZipCode

Birthdate

Firm/Occupation

Home Phone

Work Phone

Mobile Phone

Mobile Phone

Birthdate

Firm/Occupation

Email

Work Phone

Email addresses and other private information are never shared or sold. By listing your email address you authorize KJA use to assist us in keeping you informed.

Email

Children Child 1

Birthdate

School

Grade

Child 2

Birthdate

School

Grade

Child 3

Birthdate

School

Grade

Child 4

Birthdate

School

Grade

Child 5

Birthdate

School

Grade

Child 6

Birthdate

School

Grade

AJCC Pool/Tennis Summer Membership fee is $385 for a family (a family is considered individuals living within the same home or dwelling)

Non-refundable payment to KJA or AJCC must be submitted with this application New Summer Members Only:

Returning Summer Member:

New Summer Member

Returning Summer Member

OPTIONAL:

OPTIONAL:

Available to NEW 2007 AJCC Summer Members ONLY, who have never been AJCC members or summer members.

A "New Member Recruitment Incentive" of $25.00 is paid to any returning Summer Member that recruits new AJCC Summer Memberships.

My sponsor is ________________________________. Please send this person(s) the "New Member Recruitment Incentive" of $25.00

Make certain that any friends, family, neighbors or acquaintances you refer to AJCC Summer Membership list your name as "Sponsor" on their AJCC Summer Membership application when they join. When their summer membership applications are received, accepted and processed, you will receive $25.00 for each "New Member" recruited.

How did you hear about the AJCC Summer Membership? _____________ _____________________________________________________________

OFFICE USE ONLY:

Payment Method:

Date Received

Date Processed

Date Filed

Registrar Initials

Complete If Incomplete action taken

Accounting:

Incomplete

Cash

Check

VISA/MasterCard/AMEX/Discover

(action taken below)

Credit Card Number

Expiration Date

Cardholder Name

Card billing zipcode

Cardholder Signature

Date

Primary Applicant Signature

Date

Spouse/Partner Signature

Date

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