BIRC Membership Change Form

BAINBRIDGE ISLAND RECREATION CENTER
Change Request Form
Name *
Full Name
Member ID
Email Address *
Mobile Phone *
Type of Change Requested *

Upgrade Membership Type Downgrade Membership Type Start Freeze (3 month minimum) End Freeze (3 month minimum) End Membership (30 days notice or you will be charged one month's dues) Change of Contact Info (indicate individual change or group)
Effective:

Month Day Year
Date
Is this Change of info ... *

Only for you? Or for everyone in your family?
Residency Status:
Current Membership Type:
Change Membership Type TO:
Add Family Member(s)
ADD NEW Contact Info
Remove Family Member(s)
Should be Empty:

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BAINBRIDGE ISLAND RECREATION CENTER