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2. MEMBERSHIP TYPE*

   1. Individual ($15/$25)
   2. Family of Two ($25/$45)
   3. Family of Three ($35/$65)
   4. Family of Four ($50/$90)

   1. Family of Five ($60/$110)
   2. Family of Six ($75/$135)
   3. Senior 55+ ($10/$20)
   4. Daily Pass ($5/$10)
4. Name*
5. Email Address*
7. Home Address*
9. City*
10. State*
11. Zip Code*
13. Telephone Number*
14. Proof of Residency *
    We accept:
    •Valid State ID or Drivers license
    •Rental or Lease Agreement
    •Current Utility Bill
16. Emergency Contact
18. Name*
19. Phone Number*
20. Relationship*
24. Household Size:*
26. Family Setting:*

    1. Head of Household

    1. Disabled

    1. Senior 55+
28. Ethnicity:*

    1. African American
    2. Asian American

    1. Caucasian
    2. Hispanic

    1. Native American
    2. Multiracial/Other
30. Annual Household Income:*

    1. $9,000 or less
    2. $9,001 - $12,000
    3. $12,001 - $15,000

    1. $15,001 - $19,000
    2. $19,001 - $23,000
    3. $23,001 - $28,000

    1. $28,001 - $32,700
    2. $32,701 - $37,500

    1. $37,501 - $42,000
    2. $42,001 +
32. 
34. Digital Signiture*

    1. I agree to the above information
35. Date*
    Date
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field