Bower Hill Swim Club
	P.O. Box 13117
	Pittsburgh, PA 15243
	(412)-276-3131
	www.bowerhillpool.com
	2007 Dues

		Family	Senior*/Single
	If postmarked by March 15th	$425.00	$350.00
	If postmarked by April 15th	$445.00	$370.00
	If postmarked by May 15th	$465.00	$390.00
	After May 15th	$495.00	$430.00

           Postmarked dates are strictly enforced. This will be your only billing notice.

           Please print the name and age of each member of your family living in your household, including
           yourself. Membership privileges and bond will be lost if Family rosters are falsified.
           Family members must reside in your house.

           Family Name ________________________________________________________
           Address ________________________________________________________
                         ________________________________________________________

Name

Relationship

Date of Birth

           1.________________________________________________________________________

           2.________________________________________________________________________

           3.________________________________________________________________________

           4.________________________________________________________________________

           5.________________________________________________________________________

           6.________________________________________________________________________

           E-mail Address - _________________________________________________________

           Please return this completed form, survey and your check payable to:

	Bower Hill Swim Club
	P.O Box 13117
	Pittsburgh, PA 15243

          If you are using an online bill paying service, you must still send in the completed form.
          Your cancelled check is your receipt.

          * A Senior membership consists of no more than two members with one(1) family member
          of the household at least 60 years of age. If this is the first year that you are applying for
          the Senior Discount, you must submit proof of age with your application.