Platinum Level Membership Application Form

New Platinum Family Membership

Thank you for applying to join the Skinnydipper Recreation Club at the Platinum level. Please ensure that you fill in all of the required information. You will be required to show government issued photo ID to our membership department in order to complete you application.

Platinum Family Membership *

Platinum Family - $ 60.00

AANR Family Membership, Platinum

AANR Couple Membership - $ 78.50

Season Swim Pass, Platinum Family

Season Swim Pass, Platinum Family - $ 180.00

Total Amount

Please enter a Username to create an account. If you already have an account please login before completing this form.

Username *

Check Availability
Punctuation is not allowed in a Username with the exception of periods, hyphens and underscores.

Password

Confirm Password

Provide a password for the new account in both fields.

Family Info

First Name *

Last Name *

Birth Date *

Gender

Female Male Other

The club member barcode is a 9-digit code comprising 4 digits for the year first joined, 2 digits for the month and 3 digits for the sequence within that year and month. Standard format is: yyyymmnnn. Example: 200907065, the member first joined the club in July 2009 and was the 65th person to join that month. Note: If this is a new membership application, the Club Member Barcode will be entered by the Membership Secretary. If this is a renewal, the number should already be entered.

Club Member Barcode

Street Address (Home) *

City (Home) *

Province / State (Home) *

Country (Home) *

Postal Code (Home) *

Phone Number (Home) *

Email (Home) *

Government issued photo ID to be used in support of your memebership application. Examples include Canadian Provincial, Territorial or National: Driver's license, Government ID card, Indian Status card, Passport or their equivalents from another country.

ID Type *

The official, unique number (registration number, certificate number, license number, etc.)

ID Number *

Occupation

If both you and your spouse will be applying for AANR membership, we can combine your individual memberships into a couples membership and use the difference towards a free swim for you!

My Spouse will be applying for AANR membership, too.

Yes No

Please enter the full name of your spouse.

Spouse Name

Please enter your spouse's Club Member Bar Code (if known). Note: If this is a new membership application, the Club Member Barcode will be entered by the Membership Secretary. If this is a renewal, the number should already be entered.

Spouse Club Member Bar Code

If this is a new membership, you must complete your application at an event. Please bring a piece of government issued photo ID to your first event.

If you are renewing your membership and the government issued ID you used to validate your original membership has changed for any reason, please make the changes to your profile and bring in your new government issued photo ID as soon as possible.

Platinum Family Membership (new or renewal)

Platinum Level Membership Application Form