Last Name:
First Name:
	Male   Female
Date of Birth:	(dd/mm/yy)
Street Address:
Town, State & Zip:
Home Phone:
Work Phone:	(If applicable)
Cell Phone:	(If applicable)
E-mail:
Signing Up For:	(Winter/Spring 2012 - Prices as of 2/14/12) Once a week ($110) Twice a week ($190) Unlimited ($250)
	I take a family or student discount
	The name on the credit card you will be using: (Allows us to match your registration to your payment)
After submitting this form you will be taken to the online payment area. Please be sure to choose the option that matches your choice, above.
I Plan To Swim Mostly:	Weekday Mornings Weekend Mornings Lunchtimes (n/a summer sessions) Evenings Weekday Mornings & Weekend Mornings Evenings & Weekend Mornings
Comments / questions:
Please remember that this registration is only valid if you are signed up with USMS! After clicking "Submit Registration" you will be taken to the online payment area.