TVWRA 2024 Application

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TUCKAHOE VILLAGE WEST RECREATION ASSOCIATION
Physical Address: 2100 Bradon Road, Henrico VA 23238
Mailing Address: P.O. Box 29204, Henrico, VA 23242

Family Last Name: *

Referring Family?

Full Address (Please include city and zip): *

Phone Number(s): *

Email Address(es): *

Family Member Information Section

Note all members must reside at the same physical address as the Primary Member
*For members over 18 please include:

first and last name, physical description and occupation.
**For members under 18 please include:

first and last name, age as of May 1, 2024, and physical description.

Member 1:

Example: Jane Doe, 5'5 blonde, cashier

Member 2:

Member 3:

Example: John Doe, age 10, brown hair

Member 4:

Member 5:

Member 6:

Member 7:

Member 8:

Addendum for Childcare *

If yes, please submit paper form in original email to Julia Whritenour at 2805 Brandon Creek Place Henrico VA 23233

Yes

Required

Emergency Contact Name & Phone Number: *

Physician Name & Phone Number: *

Pediatrician Name & Phone Number:

Membership Selection

Please select one membership option for the 2024 season.

Returning Membership Options: *

These prices reflect the full amount of dues

Household Membership (2+ family members): $545

Individual Membership: $460

Senior Membership (1 or 2 adults of 58 years of age or older with no dependents): $460

NEW MEMBERSHIP: Please proceed to next question

New Membership Options (Subject to Availability):

Please contact Julia Whritenour with any questions (TuckahoeVillageWestRA@gmail.com)

Household (2+ family members) + Initiation Fee = $1045; if paid in full at time of joining

Individual + Initiation Fee = $960; if paid in full at time of joining

Senior (1 or 2 adults of 58 years or older) + Initiation Fee = $960; if paid in full at time of joining

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Payment Method *

Check payable to TVWRA: mailed to TVWRA P.O. Box 29204, Henrico, VA 23242

Check Payable to TVWRA : dropped off at 2805 Brandon Creek Place, Henrico, VA 23233

Electronic Payment (will incur additional processing fee)

Payment Plan, will require additional Payment Plan Arrangement Form

Pay in person @ TVWRA on 2/25

Other:

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