Membership AgreementKansas • October 22nd, 2018
Jurisdiction FiledOctober 22nd, 2018Membership Add-on Upgrades ❑ Commitment (12/mo) $_ First $ Dependent $ Dependent $ Dependent $ ❑ Pool (Single) $ ❑ Pool (Couple/Family) $ ❑ Child Care Unlimited $ Total $ Total $ Total $ Subtotal $ Tax $ Total monthly $ Amount Due at Signing Enrollment Fee $ Tax $ 1st month dues $ Total Due on Signing $ Payment InformationCredit Card: ❑ Visa ❑ MasterCard ❑ American Express ❑ DiscoverCard number: Exp. Date: Signature: Billing Address (if different): Automatic Bank Draft:Bank Name:_ Routing Number: Checking Account Number: Savings Account Number: