Summer Membership Application

Membership Application (for new members)

To join the Emory Valley Pool, please print and submit this request along with your payment and a copy of the EVRC Waiver of Liability to:

EVRC, P.O. Box 4094, Oak Ridge, TN 37831

Please email any questions to: evrc.ortn@gmail.com

Date: ______________________ Referred by (member name): ________________________________________

Name: __________________________________ Spouse's Name (if applicable):____________________________

Cell Phone: ______________________________ Cell Phone: __________________________________________

Work Phone: _____________________________ Work Phone: _________________________________________

Employer: _______________________________ Employer: ___________________________________________

e-mail address: ___________________________ e-mail address: _______________________________________

Home Address: __________________________________________________________________________________

Home Phone #: _________________________________

Family Members at above address & Emergency Contact Names/Phone #s (parents or other adults who can be notified in case an emergency or illness occurs at the pool) need to be listed on Waiver of Liability. This form is required by our insurance carrier. A copy will be kept at the pool to verify membership, and provide emergency information.

MEMBERSHIPS

____ OWNER MEMBERSHIPS-- Includes property owners in the areas of Oak Ridge bordered by the Oak Ridge Turnpike, Lafayette Dr., South Illinois Ave., Edgemoor Rd., and Melton Lake Dr. Also included are the subdivisions accessed from Melton Lake Dr. Owners have full voting rights and have the opportunity to serve on the EVRC board in lieu of annual membership dues.

Initial Membership Fee: $300 (May be split into 2 years)

Annual Owner Membership Dues: $430 due and payable prior to May 15th

_____ Option 1--$730 (initial membership fee $300 plus annual dues $430

_____ Option 2--$580 (half of initial membership fee$150 plus annual dues of $430)

_____SPECIAL MEMBERSHIP -

Annual Membership Dues: $585 due May 15th. Special Memberships are renewable each year at your request.

Please circle to indicate if you are a new or returning member: NEW RETURNING

***************************(ITEMS BELOW TO BE COMPLETED BY BOARD MEMBER)**********************

DATE ACCEPTED FOR MEMBERSHIP___________Permanent Member CERTIFICATE NO. ________________

Membership Application Approved/Completed by: _____________________________________