PIVOT Membership Application For 2024
To renew or place your membership with PIVOT, please complete this form, sign the PIVOT waiver (for new members), and mail a check to Scott Poe, PIVOT Treasurer, 118 Columbine Rd, Kingsport, TN 37660. You may also give cash or a check to any PIVOT officer. Alternatively, you may also print this form and PIVOT waiver, complete, and mail with check to Scott Poe, PIVOT Treasurer, 118 Columbine Rd, Kingsport, TN 37660. Your membership is not complete without payment!
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Name *
If this is a Renewal of Membership and all Emergency Contact and Personal Details are Unchanged, you may skip down to Membership.
Address
City
State
Zip Code
Home Telephone Number
Cell Number
Email address
Date of Birth
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Emergency Contact Details
Please insert the information below to indicate the person who should be contacted in the event of an incident/accident.
Contact Name
Emergency Contact Number
Relationship
Membership
Membership Level desired *
If you require any further information or clarification regarding this application, you may email PIVOTTNVA@gmail.com.
By typing my name (signing) this membership form, I agree to abide by the PIVOT bylaws, the Code of Conduct and the rules of the game of pickleball. I agree to pay dues annually to continue as a member. I also agree that my membership may be terminated immediately if I or my guests violate the provisions of the Park and Recreation Department rules. By signing this form, I acknowledge receipt, reading, and understanding of the PIVOT Waiver and the above referenced Code of Conduct. *
Date *
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