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SIGN UP NOW!

Participant's Name:

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Parent/Guardian Names:

Address:

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Birth Date:

_City, State, Zip-=-

Grade:

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Home Phone: - ----------- ---- i ' -- --- -

Cell/Work Phone:

Parents'/Guardian's Email:,

Sign me up for:

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YMCA membership

0 $60/[ndividuaVyear

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o $100/family/year

Fee

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List additional members, if signing up for a family membership

V-Winners Sports: Circle shirt size S

M L Teammate request

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Check box if interested in coaching ($w discount) 0

Program

Name:

 

Session

Fee

 

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Program

Name:

 

Session

Fee

Total Fees enclosed $

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Pay by check, cash, or credit card. Make checks payable to YMCA of Northern Mi chigan. All registration forms must include payment

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Credit Card Payment:

Visa/Master Card

Amount

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Signature

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Exp. Date

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Financial assistance helps ensure everyone belongs at the YMCA. Pleasecall for financial assistance information.

Send forms to: YMCA of Northern Michigan, 622 Howard St., Petoskey, M149770

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