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ANNUAL MEMBERSHIP CHANGE FORM

Per your Annual Membership Agreement: Your membership is a ONE YEAR CONTRACT with an early termination fee (equal to your balance due). Membership automatically renews after one year.  It is a member's responsibility to submit a Membership Cancellation Form in order to cancel the membership. The form must be submitted by the 18th of the month in order for the cancelation to be processed in that month.

I Agree

First Member's Name

First Name*

Last Name*
First Member's Age Acknowledgment*
First Member's Date of Birth*
I certify that I am 18 years of age or older
First Member's Change Information

Please see below for options.

First Member's Signature*
Second Member's Name

First Name*

Last Name*
Second Member's Date of Birth*
Second Member's Change Information

Please see below for options.

Third Member's Name

First Name*

Last Name*
Third Member's Date of Birth*
Third Member's Change Information

Please see below for options.

Fourth Member's Name

First Name*

Last Name*
Fourth Member's Date of Birth*
Fourth Member's Change Information

Please see below for options.

Fifth Member's Name

First Name*

Last Name*
Fifth Member's Date of Birth*
Fifth Member's Change Information

Please see below for options.

Sixth Member's Name

First Name*

Last Name*
Sixth Member's Date of Birth*
Sixth Member's Change Information

Please see below for options.

Seventh Member's Name

First Name*

Last Name*
Seventh Member's Date of Birth*
Seventh Member's Change Information

Please see below for options.

Eighth Member's Name

First Name*

Last Name*
Eighth Member's Date of Birth*
Eighth Member's Change Information

Please see below for options.

Ninth Member's Name

First Name*

Last Name*
Ninth Member's Date of Birth*
Ninth Member's Change Information

Please see below for options.

Tenth Member's Name

First Name*

Last Name*
Tenth Member's Date of Birth*
Tenth Member's Change Information

Please see below for options.

Parent or Guardian's Email Address

Email*
A signed copy of this waiver will be sent to the email address you provide.
Changing Contact Information

Name

Address

Phone

Email
Changing Membership Type
Changing from Individual to Family Membership
Changing from Family to Individual Membership

If switching to Family Membership, family members must complete a Membership Agreement and Liability Waiver which can be found on our website.

Adding Locker

Men's Locker #

Women's Locker #
$120/year - must be paid at the front desk.
Add to Auto Debit
Paid in Full
Pro-rate (send with next invoice)
Changing Auto Debit or Updating Payment Method
First-year Auto Debit members cannot stop and restart their Auto Debit until their 1-year contract is fulfilled.
Add boat to Auto Debit
Switch to Auto Debit
Pause Auto Debit (must include restart date below)

Restart Auto Debit on:

If switching to Auto Debit or if you need to update your payment method, please enter your card information below. The change will not be processed if this is not completed.


Cardholder Name

Card Number

Exp Date

Billing Address (Street, City, Zip)

CVC
Changing Boat Storage

Adding Boat


Make / Model / Color

Storage Space

Changing Space Location


Old Storage Space

New Storage Space
Other Membership Changes

Let us know if you need to make other changes to your membership (ex: joining the Adult Outrigger Team and need to add dues to your membership)


The undersigned parent and/or legal guardian does hereby represent that he/she is, in fact, acting in such capacity and agrees to release and indemnify each and all of the Released Parties referred to above from all liability, loss, cost, claim or damage whatsoever which may be imposed upon said Released Parties because of any defect in or lack of such capacity to so act and release said Released Parties as specified in this Agreement. THE UNDERSIGNED PARENT AND/OR LEGAL GUARDIAN ALSO ACKNOWLEDGES THAT THEY HAVE CAREFULLY READ THIS LIABILITY RELEASE, ASSUMPTION OF RISK AND INDEMNIFICATION AGREEMENT LINE BY LINE, THEY UNDERSTAND ITS CONTENTS AND AGREE TO BE BOUND BY THE TERMS.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Change Information

Please see below for options.

Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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