Membership at Community Fieldhouse
Primary Account Holder
Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
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Membership Tiers
*
Basic Membership (families up of 4) $55/mo
Supreme Membership (families up to 5) $60/mo
Ultimate Membership (families up to 6 or MORE) $70/mo
Additional Members
members on your membership MUST be household and immediate family members ONLY
Member #2
Member #2 Full Name
First Name
Last Name
Member #2 Date of Birth
-
Month
-
Day
Year
Date
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Member #3
Member #3 Full Name
First Name
Last Name
Member #3 Date of Birth
-
Month
-
Day
Year
Date
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Member #4
Member #4 Full Name
First Name
Last Name
Member #4 Date of Birth
-
Month
-
Day
Year
Date
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Member #5
Member #5 Full Name
First Name
Last Name
Member #5 Date of Birth
-
Month
-
Day
Year
Date
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Member #6
Member #6 Full Name
First Name
Last Name
Member #6 Date of Birth
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Month
-
Day
Year
Date
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Signature
*
Submit Application
Submit Application
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