Black Ski Membership

Black Ski Membership

New Membership or Renew Membership Form - v4
Type Membership*

New MembershipRenew MembershipRenew with Changes
Email*
example@example.com
Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date
Gender

MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone
Please enter a valid phone number.
Cell Phone
Please enter a valid phone number.
New Member Selection

Single - $55Family - $90Youth - $20Lifetime - $500
Renew Member Selection

Single - $30Family - $45Youth - $10
Family Members (Spouse, Children 7-18 in same house)
Sport

SkiBoardOther
Level

NewBeginnerIntermediateExpert
Emergency Contact*
Signature*

Clear
Date

MonthDayYear
Date
Comments
Payment Due: {typeMembership} - {newMember}{renewMember}

Pay By CheckPay By PayPal (service fee added)
PayPal / Credit Card Note: For those who don't have a PayPal account. One can pay with a Credit Card via PayPal. Sign in to PayPal as a Guest. Then specify a Credit Card payment and enter Credit Card info.
Pay By Check

Send {newMember} {renewMember} Payment to:

Black Ski, Inc, PO Box 90762, Washington, DC. 20090-0762

Write: {typeMembership} on check

Print this form and include 1st two pages with check
PayPal Payment (service fee added)
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New Single
$57.50



New Family
$93.76



New Youth
$21.23



Renew Single
$31.59



Renew Family
$47.14



Renew Youth
$10.87



New Lifetime
$518.59



Total

$0.00
Contact: L'Tanya Talley, tal8ley@gmail.com
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