NS-SC.org Online Membership Form

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Thank you for your joining the North Springfield Swim Club! Please note that this is an online membership form for membership who are joining the pool and is NOT an inquiry form for those requesting formation about the pool. For questions about joining, please contact our Membership Director, Ken Balbuena, at MembershipNSSC@gmail.com

Memberships paid via check can be mailed to:
North Springfield Swim Club
P.O. Box 1209
Springfield, VA 22151

To pay online after completing this form, please visit the "Payment" tab under the "Membership" drop-down menu to be directed to our PayPal portal where you can pay by credit card or PayPal. Please note that there will be a 3.6% convenience fee added to all electronic payments.

Family Name for Membership *

Membership # (Leave blank if unknown or a new member)

Member #1: First Name

Member #1: Last Name

Member #1: Date of Birth

YYYY

Member #1: Authorized To Sign In Guests

Email Address *

Additional email addresses to be added to our contact list.

Street Address *

Street Address 2

City *

State *

Zip Code *

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