Arc Achievers

2015

Membership Enrollment Form

General Information Date:

Name of program participant:

Address:

Home# Cell# Email:

Name of Parent / Guardian:

Parent cell phone/email:

Name and phone number of one (1) back up person who may be contacted in case of emergency (must be other than parent / guardian):

Below please indicate which type of membership you are selecting. Arc Achievers membership runs from 7/1/15 - 6/30/16:

____Standard membership ($30) This membership is our standard savings plan. It entitles the member to Arc Achievers prices when purchasing tickets to recreation events throughout the year.

____Plus Membership ($50)This membership come with all the benefits of a Standard membership, PLUS each member will receive a free member only catered dinner in the Spring of 2016 and a $5 coupon to use on our PODS transportation system

____Group Membership ($150)This membership come with all the benefits of a plus membership. In addi-tion it is valid for up to four(4) people per event, and is valid for up to 4 individuals at our catered membership dinner. It also includes 4, $5 coupons to ride the PODS transportation system. Perfect for organizations and families.

Method of Payment: Check Check #

Credit Card Credit Card Type

Credit Card number

Exp Date

For Questions, please contact Recreation Manager Drew Zimmerman at 609-406-0181 x101 or dzimmerman@arcmercer.org

Please return Enrollment Forms to Drew Zimmerman at 180 Ewingville Rd, Ewing, NJ 08638