Anna Maria Island Community Center
Membership Registration Form


*** GRAND OPENING SPECIAL ***
expires June 30, 2008


Membership to the Center helps support our Youth and Adult Programs. We offer our membership a discount to most of our classes and Youth Programs.

Please fill out the form below. If you plan to make your payment at the Community Center, just print out this form and bring it with you. If you want to mail a check, print out the completed form and send it along with your check. If you want us to put your membership payment on your charge card, submit the completed form and the office will call you for further information (do not put your credit card number on the form). You also have the option to pay your membership online via our PayPal account. If you check this option, we will email you an invoice with a link to PayPal where you can make your payment.

Contact Information: (* denotes required fields)
*Name 
*Street 
*City  *State  *Zip 
*Home Phone  Cell Phone  Work Phone 
*Email 

Type of Membership
MEMEBERSHIPMonthly6 MonthsAnnual
Child (4-17yrs)  $30.00
Adult (18-59yrs)$12.00$65.00$125.00
Senior (60+)$10.00$55.00$100.00
Family (2+ members)  $250.00
 
FITNESS ROOM ONLY$25.00$150.00$295.00
Must be18yrs old - Day Passes available for $5.00
TENNIS MEMEBERSHIP
 30day60days90day6monthAnnual
Single$40.00$60.00$80.00$100.00$140.00
Couple$60.00 $90.00$120.00$150.00$210.00
Day Pass - $5.00
 
COMBO (USE OF FITNESS ROOM PLUS CENTER MEMBERSHIP)
Adult (18-59) $180.00$325.00
Adult Couple $300.00$575.00
Senior (60+) $170.00$300.00
Senior Couple $275.00$500.00
 
ELITE (USE OF FITNESS ROOM PLUS CENTER AND TENNIS MEMBERSHIP)
Adult/Senior - Single (18-59) $300.00$575.00
Adult/Senior - Couple $425.00$900.00
 
DAY PASSES Will allow you to take any class at the NON-MEMBER RATE. Passes are available at the front desk for $5.00.
GUEST PASS Members may bring a guest at a cost of $5.00 per visit. The member's guest will be offered a tone-time free trial class at no additional cost.


* List names of persons included in your Family Membership
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Waiver for Participation

In consideration of your accepting my/our registration fee, I hereby, for myself, my dependent(s) and minor children, and our executors and administrators, waive and release any and all rights and claims for damages I or my dependent(s) or minor children have or may have against Anna Maria Island Community Center and it’s representatives, successors, employees, contractors, or volunteers (collectively AMICC) for any and all injuries or death suffered by myself, my dependent(s) or minor children at any activity sponsored or monitored by AMICC, held upon its property, or through the use of its equipment. If I or my minor children or dependent(s) should suffer and injury, illness, or death while participating in an activity, I authorize AMICC instructors to use their sole discretion in having me or my dependent(s) and minor children transported to a medical facility and I take all responsibility for this action, including costs. I authorize the medical facility to render any emergency treatment deemed necessary. Also, I understand that no refunds are given unless the activity is canceled or a doctor’s release is presented. I understand that this release is a full and final release of all claims of any nature whatsoever for myself, my minor children or dependents including but not limited claims arising due to the sole joint, contributory, concurrent or gross negligence of AMICC. I understand that this release includes my minor children and I represent that I am the authorized guardian for my minor children.

I have read the waiver and agree I have read the waiver and disagree




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