First Name:
Last Name:
Street:
City:
State:
Zip:
Cell Phone:
Email:
Birthday:
Gender:
Female
Male
Emergency Contact Name:
Emergency Contact Number:
How did you find out about us:
Centenary Affiliation(circle if applicable):
None
Alumni
Student
Active Military
Senior Citizen
UMC Clergy
Receives 20% discount
Membership Type:
Individual Membership: $495/yr plus $25 sign-up fee
Individual Membership: $45/mo plus $25 sign-up fee
Centenary Affiliation: $396/yr. plus $25 initial sign-up fee
Centenary Affiliation: $36/mo. plus $25 initial sign-up fee
Family Membership: $825/yr. plus $50 initial sign-up fee
Family Membership: $75/mo. plus $50 initial sign-up fee
Centenary Affiliation Family: $660/yr. plus $50 initial sign-up fee
Centenary Affiliation Family: $60/mo. plus $50 initial sign-up fee
Payment Option:
Credit Card
Bank Account
Card Type:
N/A
Visa
MasterCard
Discover
Name of Bank:
Name on Account/Card:
Routing #:
Account/card #:
Expiration Date:
Promo Code:
Please type any questions or comments