White Plains Ski Club

Membership Registration Form

2017-2018

 

Please print, complete, and return this form with your check payable to “White Plains Ski Club” to

Diane Steiker, 255 Fieldston Terrace, Apt 6L, Bronx, NY 10471.

 

Due date is December 1st. Note, no reservations will be accepted until all fees are paid in full

                       

Name: ___________________________________________________________________________

Street:  __________________________________________________________________________

City:  _______________________________   State:  _________________  Zip:  _______________

Home Ph:  __________________    Cell Ph1:  _________________  Cell Ph2: ____________________

Email1:  ______________________________   Email2:  __________________________________

Please identify membership type (Single, Single Family, or Family) ________________________

Single Family and Family members, please list all children's names and ages: ______________

_________________________________________________________________________________

 

Membership Type

Single

Single Family

Family

Dues:

Please circle appropriate dues according to membership type. Applies to all provisional and full members.

 

$100

 

$100

 

$200

Advance Trip Deposits:

Please circle appropriate advance trip deposit fees according to membership type. Applies to all provisional and full members.

 

$160

 

$320

 

$320

Initiation Fee:

Initiation fee applies only to new members upon formal acceptance and returning members after a year or more absence.

 

$150

 

$150

 

$250

Work Weekend Penalty:

Work weekend penalty applies only to full memberswho did not complete a work weekend during the proceeding summer or fall season. It does not apply to first year Provisionals.

 

$75

 

$75

 

$150

Late Registration Fee:

Late Registration Fee applies only to provisional or full members who are paying after December 1st.

 

 

$25

 

$25

 

$25

Please total dues, advance trip deposit, and any applicable additional fees.

 

Check #:  __________________                               Total Amount Due: $ _____________________

 

 

Signature:  ________________________________________        Date:  ______________________

 

Please direct any questions to Diane at ddsteiker@gmail.com.  Thank you!