Program Interest Form
Thank you for taking part in activities at the Specter Center - the world's largest community squash center and home of US Squash!
Participant's Full Name
*
First Name
Last Name
Participant's Date of Birth
*
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Month
-
Day
Year
Participant's Gender
*
Male
Female
Non-Binary
Prefer not to say
Participant's Phone Number
*
Participant's Email
*
Emergency Contact: Full Name + Phone Number
*
All Clinic packages are non-refundable.
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Signature
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September Package
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Free
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Member Clinic Price
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November Package
$
Free
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Member Clinic Plan
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December Package
$
Free
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Member Clinic Plan
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Credit Card Details
First Name
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Credit Card Number
Security Code
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