350 after eb $370 $385 after eb $405 $295 after eb $315

2016 PISCINE VILLAGE DE POINTE CLAIRE FORMULAIRE D'ABONNEMENT- POINTE CLAIRE VILLAGE POOL MEMBERSHIP FORM 2016
NOM DE FAMILLE / FAMILY NAME
MÈRE - MOTHER'S NAME
PÈRE - FATHER'S NAME
ADDRESSE RUE - STREET ADDRESS
VILLE - CITY
CODE POSTAL - POSTAL CODE
MÈRE - MOTHER
PÈRE - FATHER
TÉL MAISON - HOUSE PHONE
TÉL BUREAU - OFFICE PHONE
TÉL CELLULAIRE - MOBILE PHONE
COURRIEL - EMAIL
NOMS D'ENFANTS - CHILDREN'S NAMES
AGE
DATE DE NAISSANCE - DOB
PVPC website/site web:
http://pvpcweb.yolasite.com/
http://www.ville.pointePointe Claire Outdoor Swimming claire.qc.ca/en/2013-02-05-13-34Pools / Les piscines exterieures
38/outdoor-pools.html
de Pointe Claire:
RATES: EARLY BIRD RATES APPLY TO MEMBERSHIPS & PAYMENTS RECEIVED ON/BEFORE MAY 28, 2016. AFTER
THE REGISTREATION DATE OF MAY 28TH, AFTER EARLY BIRD (EB) RATES APPLY.
CATÉGORIE D'ABBONNEMENT RESIDENTS DE P.C./MEMBERSHIP CATEGORY P.C. RESIDENTS
X
ALPs:
http://www.jumptoalps.com/index.htm
Facebook:
https://www.facebook.com/publicpool?
ref=hl
PVPC et ses membres doivent se conformer au Code de Conduit ALPS
PVPC and its members must abide by the ALPS code of conduct
NON-P.C. RESIDENT/
NON RESIDENT DE P.C.
Aucun remboursement des frais d'abonnement après le début des programmes
FAMILLE - FAMILY
$350 AFTER EB $370
$385 AFTER EB $405
ADULT (18+) & CHILD
$295 AFTER EB $315
$335 AFTER EB $355
ADULTE - ADULT (18+)
$140 AFTER EB $150
$160 AFTER EB $170
JEUNE - YOUTH (12-17)
$155 AFTER EB $165
$175 AFTER EB $185
Date:
COUPLE (2 ADULTS/2 ADULTES)
$235 AFTER EB $255
$260 AFTER EB $280
Montant payé - Amount paid
SENIOR - SENIOR (60+)
$60 AFTER EB $70
$75 AFTER EB $85
par cheque ou comptant - by check or cash
SENIOR COUPLE - COUPLE SENIOR (60+)
$100 AFTER EB $110
$115 AFTER EB $125
cheque # - check #
No refund on membership fees once the programs have begun
Signature: