PIVOT Membership Application For 2022
We are trying this year to accomplish the membership enrollment and renewal process without paper, but if preferred, you may print the form, complete, and send with a check made out to PIVOT, to PO Box 7708, Kingsport, TN 37664-7708.
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Applicant Personal Details:
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 and Zip Code
Home Telephone Number
Cell Number
Email address
Date of Birth
MM
/
DD
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YYYY
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 *
MM
/
DD
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YYYY
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