Life Membership Form

LIFE MEMBERSHIP FORM

MEMBERSHIP FOR WESLEY COLLEGE SWIMMING POOL

CATEGORY:  FAMILY INDIVIDUAL
Date:
Name:
Address:
Profession/Occupation:
Period at Wesley:
Contact Land Line No:
Contact Mobile No:
Email Address:
For family membership only
Name of Spouse:
Name of Children between ages of 5-16
Name of Child 1: Age:
Name of Child 2: Age:
Name of Child 3: Age:
Name of Child 4: Age:
Name of Child 5: Age:

Payment Amount:



You could make a part payment and reserve your membership before 30th November 2011

Mode:

 CHEQUE CASH DIRECT DEPOSIT

Anti-Spam:

Please type the answer to 1+5