The Arlen Specter Center US Squash Center Sponsored Membership Application
Thank you for your interest in joining our community. This application is for individuals or families that demonstrate financial need. After completing this application, the Membership Director will review your information and contact you within 5-7 business days. Specific membership inquiries can be sent to membership@spectercenter.org.
Primary Member Full Name
*
First Name
Last Name
Primary Member Email
*
example@example.com
Primary Member Mobile Phone
*
Please enter a valid phone number.
Primary Member Date of Birth
*
-
Month
-
Day
Year
Date
Primary Member Gender
*
Male
Female
Non-Binary
Prefer not to say
Race
*
Please Select
Black or African American
White
Hispanic or Latinx
Asian
American Indian/Alaska Native
Native Hawaiian/Other Pacific Islander
Other Race
Prefer not to say
Preferred Language
*
Primary Member Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact: Full Name + Phone Number
*
Does your family meet Federal Free Lunch Income Criteria?
*
Please Select
Yes
No
Prefer not to say
Do you meet federal free/reduced lunch criteria (Family of 1 less than $24k/year, Family of 2 less than $32k/year, 3 $41k, 4 $49k, 5 $57k, 6 $65k, 7 $74k, 8 $82k)
Are you interested in receiving assistance for Specter Center programming?
*
Please Select
Yes
No
Did you participate in the Philadelphia Public Squash League?
*
Please Select
yes
no
If your family does not meet the free lunch income criteria, you may share why financial assistance would be helpful to your family.
Sponsored Memberships are reduced in cost, but we encourage all members to contribute to the Community Fund. The Community Fund enables additional families and youth to participate in programs at the Specter Center. How much would you like to donate each month?
*
Please share your membership interests.
*
Not Interested
Interested
Very Interested
Playing with Friends
Competitive Leagues
Private Lessons
Group Clinics
Social Events
Number of Additional Designees (Partner or Dependents). Children under 14 must be accompanied by an adult. Designees will be approved at the same discounted rate as the Primary Member.
*
Please Select
0
1
2
3
4
5
6
7
8
9
Designee 1 Name
First Name
Last Name
Designee 1 Date of Birth
-
Month
-
Day
Year
Date
Designee 1 Email
example@example.com
Designee 1 Phone
Please enter a valid phone number.
Designee 1 Relation to Primary Member
Designee 2 Name
First Name
Last Name
Designee 2 Date of Birth
-
Month
-
Day
Year
Date
Designee 2 Email
example@example.com
Designee 2 Phone
Please enter a valid phone number.
Designee 2 Relation to Primary Member
Designee 3 Name
First Name
Last Name
Designee 3 Date of Birth
-
Month
-
Day
Year
Date
Designee 3 Email
example@example.com
Designee 3 Phone
Please enter a valid phone number.
Designee 3 Relation to Primary Member
Designee 4 Name
First Name
Last Name
Designee 4 Date of Birth
-
Month
-
Day
Year
Date
Designee 4 Email
example@example.com
Designee 4 Phone
Please enter a valid phone number.
Designee 4 Relation to Primary Member
Designee 5 Name
First Name
Last Name
Designee 5 Date of Birth
-
Month
-
Day
Year
Date
Designee 5 Email
example@example.com
Designee 5 Phone
Please enter a valid phone number.
Designee 5 Relation to Primary Member
Designee 6 Name
First Name
Last Name
Designee 6 Date of Birth
-
Month
-
Day
Year
Date
Designee 6 Email
example@example.com
Designee 6 Phone
Please enter a valid phone number.
Designee 6 Relation to Primary Member
Designee 7 Name
First Name
Last Name
Designee 7 Date of Birth
-
Month
-
Day
Year
Date
Designee 7 Email
example@example.com
Designee 7 Phone
Please enter a valid phone number.
Designee 7 Relation to Primary Member
Designee 8 Name
First Name
Last Name
Designee 8 Date of Birth
-
Month
-
Day
Year
Date
Designee 8 Email
example@example.com
Designee 8 Phone
Please enter a valid phone number.
Designee 8 Relation to Primary Member
Designee 9 Name
First Name
Last Name
Designee 9 Date of Birth
-
Month
-
Day
Year
Date
Designee 9 Email
example@example.com
Designee 9 Phone
Please enter a valid phone number.
Designee 9 Relation to Primary Member
Please submit the following documentation: (1.)Most recent year’s 1040 Federal Tax Return (2.)Two most recent pay stubs for all adults in the household If you are unable to provide the required documentation please email membership@spectercenter.org
*
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