New Member Intake Form

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Full Name

*

Email

*

This address will receive a confirmation email

Secondary Email (optional)

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Phone

*

Preferred Method of Contact

*

Please select one option.

Email Phone Text

Opt-in Text Announcements?

*

Please select all that apply.

Yes No

Address

*

Please write the names & ages of others in your household

Name(s)/Age(s)

Getting to Know You - Share you Interests Below:

Games

Please select all that apply.

Cards (Bidwiz, Spades) Board games Bingo

Activities

Please select all that apply.

Fishing Bowling Kickball Basketball

Additional comments or questions?

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Description

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