Membership Form
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Membership Type *
Please choose one (If you're looking for corporate/business memberships, please contact us directly at info.stlcfl@lc.edu).
For Individual Memberships Only
All responses for this section are required. If you are joining with a family or as a group, skip to the next section.
Member Name
Please sign your full name (i.e. John Q. Public)
Date of Birth
MM
/
DD
/
YYYY
For Family/Group Memberships Only
Today's Date
MM
/
DD
/
YYYY
Adult Family Member #1
Please sign your full name (i.e. John Q. Public)
Date of Birth
MM
/
DD
/
YYYY
Adult Family Member #2
Please sign your full name (i.e. Jane Q. Public)
Date of Birth
MM
/
DD
/
YYYY
Please list additional family members and their d.o.b.
(i.e. Sally Public - age 9, Jess Public - age 10)
Contact Information
We will use this to contact you about your account.
Name *
First and Last name
Street Address *
City, State, Zip Code *
Phone *
Email address *
Other
Electronic Signature
The electronic signature of an adult member is required to validate this form. *
Please sign your initials (i.e. JQP) to verify that you are an adult and that all the information submitted is accurate, to your knowledge.
Payment
After you submit this form, click on the link on the confirmation page to process your payment and complete your membership enrollment.
Submit
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