Membership Form Which program(s) are you participating in? Lap Swim Masters Swim Team Water Polo Adult Applicant - Billing Member * First Name Last Name Date of Birth Phone * (###) ### #### Email Address * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Emergency Contact Name & Phone Number * Adult Co-Applicant First Name Last Name Date of Birth Phone (###) ### #### Email Address Address Address 1 Address 2 City State/Province Zip/Postal Code Country Emergency Contact Name & Phone Number Child Name & Date of Birth Child Name & Date of Birth Child Name & Date of Birth Child Name & Date of Birth Thank you for applying to become a Coggan Family Aquatic Complex member! We will call you within 72 hours to finalize your membership.
