Glenpool Membership Application

Glenpool Club

Membership Application
Today's Date:

MonthDayYear
Date
Before submitting this application, please read the by-laws and pool rules at https://glenpoolclub.org/ to make sure that you understand all of your responsibilities for becoming a member of Glenpool Club. If you have further questions you may contact a board member at glenpoolclub@gmail.com or call/text Lisa at 570-412-4317.
Head(s) of the household:

First NameLast Name
Home Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone:*
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Family $500Couple $350Single $300Lap $200
Famiily Memberships please list any additional members of the immediate household and their birthdates. Couple Memberships please enter the additional member not listed as Head of Household above. Members must actually reside at the above address, unless designated as the child’s caregiver while at the pool.
First Name Last Name Birthdate
First Name Last Name Birthdate
First Name Last Name Birthdate
When finished, submit the form by clicking the submit button below. You will receive an email confirmation about the status of your application shortly therafter. You will be emailed an invoice for the application fee of ($25 if application is dated before April 30th or if dated May 1 and beyond the fee is $50) along with your membership fee. The application fee is non-refundable.

Thank you!
Should be Empty:

Glenpool Club