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2023 Eastmoor Pool Membership Registration Form
Eastmoor South Recreation Park
PO Box 091095 Columbus, OH 43209
735 Eastmoor Blvd.43209
OPENING DAY: Saturday, May 27, 2023
*Rates are staying the same as 2022*
* Indicates required question
Email
*
Your email
Adult 1, Last Name
*
Your answer
Adult 1, First Name
*
Your answer
Adult 1, Email
*
Your answer
Adult 1, Phone Number
*
Your answer
Adult 1, Home Address
*
Your answer
If applicable: Adult 2, Last Name
Your answer
If applicable: Adult, 2 First Name
Your answer
If applicable: Adult 2, Email
Your answer
If applicable: Adult 2, Phone
Your answer
Children Name(s), Birthdate:
Your answer
Emergency Contact (name, relationship, phone)
*
Your answer
If you are a Eastmoor Pool Bond Owner, enter your Bond # below (Note: shareholders with a valid bond receive a 10% discount with proof of bond):
Your answer
Membership Categories and Rates (please select one)
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Family Membership: $440.00
Couple Membership: $275.00
Individual Membership: $200
Senior Couple (65+) Membership: $205.00
Senior Individual (65+): $110.00
Babysitter/Sittee: $75
Please indicate how you plan to pay for your 2023 Eastmoor Pool Membership:
*
Payment made via VENMO @eastmoorpool *NOTE, please add the 1.9% processing fee to your payment
Drop off cash/check/money order to Elyse Salisbury (Board Membership Committee): 80 S. Chesterfield Rd.
Drop off cash/check/money order to Beth Sission (Board Finance Committee): St. Catharine's Parish Office
Mail cash/check/money order to Eastmoor Pool: PO Box 091095 Columbus, OH 43209
By typing my name below, I confirm that this information is correct, and I agree to submit my payment in the manner indicated above.
*
Your answer
A copy of your responses will be emailed to the address you provided.
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