2016 BTC Summer GROUP Swim Lessons

2016 BTC Summer GROUP Swim Lessons
BTC Members

YesNo
First Adult*

First NameLast Name
First Adult Email*
Second Adult

First NameLast Name
Second Adult Email
Summer Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone 1*

Area CodePhone Number
Phone 2

Area CodePhone Number
Child One
Name
Child One Age
Child One Sessions

July 5-14th ($120 Member / $180 Nonmember)July 18th-28th ($120 Member / $180 Nonmember)
Child One Swim Group
Child Two
Name
Child Two Age
Child Two Swim Group
Child Two Sessions

July 5-14th ($120 Member / $180 Nonmember)July 18th-28th ($120 Member / $180 Nonmember)
Running Total $
prevnext( X )
USDTotal Due
Should be Empty: