CHATEAU GIFT MEMBERSHIP REGISTRATION

Membership Recipient Information:

Type of Membership: *

Student ($30.00)

Individual ($45.00)

Couple ($60.00)

Family ($100.00)

Primary Member First Name *

Primary Member Last Name *

2nd Member First Name

2nd Member Last Name

3rd Member First Name

3rd Member Last Name

4th Member Last Name

4th Member First Name

Address *

Address 2

City *

State/Province *

Zip/Postal Code *

Country *

Primary Phone Number: *

Secondary Phone Number:

Email Address *

Your (Gift Giver) Information:

First Name *

Last Name *

Address *

Address 2

City *

State/Province *

Zip/Postal Code *

Country *

Home Phone Number: *

Mobile Phone Number: *

Email Address *

Preferred way to contact *

Phone

Email

Any

Please indicate how you learned about Chateau:

Terms and Conditions *

You consent to receive communications from us electronically. We will communicate with you by e-mail or phone. You agree that all agreements, notices, disclosures and other communications that we provide to you electronically satisfy any legal requirement that such communications be in writing.

Please sign *

clear