Parklawn Recreation Association
Application for Membership, 2011

*  Please print this form, fill it up and send it to us to the address bellow.  Thank you.  

Family Name:      
Mailing Address:      
Phone:      
email:      
Referred By: :  

Family members in your home: (More than six please submit second page)

Names

 Adult Child Child Age
    o o  
  o o  
    o o  
     o o  
  o o  
  o o  

Membership Category Options (Please select one):

     Family Membership

$475/$545
The $475 rate is a promotional rate for first-year new members.  The current family rate is $545.
     Adult Only Membership - single or couple, no children $275/$315
The $275 rate is also a promotional rate for first-year new members.  The current adult only membership rate is $315.
     Senior Citizen Single - age 65 or older $145

Note: With the three membership categories above, you will receive a Certificate of Membership and become a voting member of PRA, with all rights and responsibilities associated with being a member of PRA.  A copy of the by-laws will be included with the certificate.
     Associate Youth Pass (ages 15-20) (no eligibility for swim team) $200

Mail this application and your check to:
Parklawn Recreation Association
P.O. Box 11162
Alexandria, VA 22312

Check here for information about swim team: ____  swimming lessons: ____  guest passes: ____