2025 Membership Form

2025 Member Form

800 Bingham, Victoria, TX 77904
Are you a new member or a returning member:*
Member Number (returning members only)
Primary Member*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Email*
Phone Number*
Alternate Number
Name and Number of Emergency Contact*
first and last name, phone number
Family Members Living in Your Household
Primary Member*

NameAge
Member 2

NameAge
Member 3

NameAge
Member 4

NameAge
Member 5

NameAge
Member 6

NameAge
Member 7

NameAge
Member 8

NameAge
Please list any other household members OR special circumstances to be addressed by the board (caregivers, etc)
Memberships are not complete until paid in full.
Payment options*

Venmo (we will send a payment request)Credit Card *subject to processing fee* (we will email a Paypal invoice - does not require a Paypal account)In Person: bring payment to the pool during open hours OR text 361-218-9246 to make alternate arrangementsBy Mail: send check to Northcrest Pool, P.O. Box 7513, Victoria, TX 77903
Should be Empty:

2025 Member Form