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Pool Registration for 2011 season
* First Name:
* Phone Number:
* Last Name:
Mobile Number:
* Address 1:
Work Number:
Address 2:
Email:
* City:
Emergency Contact Information
* State:
< Choose >
AK
AL
AR
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CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
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ME
MI
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MS
MT
NC
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NY
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OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
* Name:
Zip:
* Phone:
Membership Level Costs
Please select the type of membership you would like:
Type
Membership Level
Fee
Mail or Drop off payments to:
Individual
$125.00
Village of Sloatsburg
96 Orange Turnpike
Sloatsburg
,
NY
10974
Family
$300.00
Senior Citizen
$25.00
*Make checks out to Village of Sloatsburg
*If you are a first time pool pass member, please submit a copy of your NY State Driver�s License with Sloatsburg address or a copy of a current utility bill as proof of residency.
Village of Sloatsburg
96 Orange Turnpike
Sloatsburg, NY 10974
info@sloatsburgny.com
Copyright © 2004, VILLAGE OF SLOATSBURG
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