membership form

COURSE REGISTRATION & MEMBERSHIP FORM
Marshfield Branch, Cambridge YWCA - Ferry Hill Road, Marshfield 02050 - 781.834.8371

Name:

Mailing Address:

City:

Zip Code:

Home Phone:

E-Mail:

Class Name:

Fee:

Playroom?
Names & Ages of Children:

Fee:

Class Name:

Fee:

Playroom?
Names & Ages of Children:

Fee:

Class Name:

Fee:

Playroom?
Names & Ages of Children:

Fee:

Totals for Classes & Playroom

Membership: New Renewing

Date of Birth:

Fee: $30 for an Adult, $5 for a Child

Contribution:

Credits:

Total:

Ethnic Background (Optional Information - Please Circle)
American Indian	Asian	Black	Black Hispanic	White	White Hispanic	Other

I would like to help with:
Fundraising	Programming	Policy Making	Building & Grounds

Yearly Membership Fees are: Over 18 - $30.00, 0-18 $5.00
Prearranged Babysitting Fees: $4 for first child & $2.00 for each additional child Drop in: $6/child per morning.

If you are a new member please tell us how you heard about the YWCA.