I am requesting membership in the Valkyrie Squash Club.

* = required field

*Please select the type of membership that you are requesting:
 Single       Husband and Wife       Family (children under 11)       Junior

*Last Name       *First Name       Middle Initial  

*Home Address  

*City        *State        *Zip  

*Home Phone        Work Phone  

*E-Mail Address  

First name of Candidate’s Spouse  

First name(s) of Candidate’s child(ren):
1.  
2.  
3.  

Applicant’s Sponsor  

When was your most recent physical?  

Do you take any medication?   Yes      No

If Yes, name of medication  

Please note, the Valkyrie Squash club strongly recommends a physical be performed prior to engaging in any strenuous activity, such as squash.
 

Method of Payment: Credit Card - we gladly accept Visa, Master Card and American Express.

*Credit Card #         *Expiration Date