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MEMBER INFORMATION

Plan

Term Length

Membership Type

# of Members

Would you like to add kids (Kids 14-21) to your monthly membership?

Yes (+$35.00 Monthly)

Would you like to add kids (Kids 14-21) to your 6 Month membership?

Yes ($210.00 Paid-In-Full)

Would you like to add kids (Ages 14-21) to your 12 Month membership?

Yes ($420.00 plus tax per child for 12 months)

Total Monthly Price

Total Price - 6 Month Term

Total Price - 12 Month Term

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Last Name *

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Applicant Email *

Mailing Address *

Mailing Address

Street Address

Mailing Address

City

State/Province

Zip/Postal

Date Of Birth

Gender

Company/Occupation

Emergency Contact Name *

Emergency Contact # *

Contact Relationship

Applicant #2 Information

First Name *

Last Name *

Phone *

Applicant Email *

Mailing Address *

Mailing Address

Street Address

Mailing Address

City

State/Province

Zip/Postal

Date Of Birth

Gender

Company/Occupation

Emergency Contact Name *

Emergency Contact # *

Contact Relationship

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STUDENT SPECIAL! $60 per month

The Edge VT Senior Memberships

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MEMBER INFORMATION

Applicant #2 Information