Bower Hill Swim Club
                            www.bowerhillpool.com
                               412-276-3131

                           MEMBERSHIP APPLICATION


Family Name (Print or Type) ________________________________________________

Address____________________________________________   Phone_________________

City_______________________________________________   PA   Zip Code_________

Email Address_______________________________________________________________

Applicant's Signature______________________________   Date__________________


            Please Print Names of Family Members Living in Household

    ************  Name ************       * Relationship *     Date of Birth

1. __________________________________    __________________    _____________

2. __________________________________    __________________    _____________

3. __________________________________    __________________    _____________

4. __________________________________    __________________    _____________

5. __________________________________    __________________    _____________

6. __________________________________    __________________    _____________

7. __________________________________    __________________    _____________

8. __________________________________    __________________    _____________

9. __________________________________    __________________    _____________


Please make checks payable to:  Bower Hill Civic League Swim Club

Mail Application to:  Bower Hill Civic League Swim Club
                                   P.O. Box 13117
                                   Pittsburgh, PA 15243

If an existing member referred you to the Club,
please print their name below:

__________________________________________________________________________