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WINTER 2010 Program Registration (page 1 of 3)


Please enter your basic family information.  You will then be able to register for programs.  You will be able to sign multiple people for multiple classes in the same internet session.  If you sign off, you will have to renter your family information.

Family Information Information
Last Name:  
Address:  
City/State/Zip:   /             /
Phone:  Home           Emergency

I wish to receive confirmation/status of my class choices by:

Fax at:                or  Email at:


 

Where Did You Hear About Us?

Select all that apply

I am a Member:   

I have taken classes here before:   

Received Program Guide in Mail:   

Ad in Pioneer Press:   

Other Ad:   

Referred by:   

Promotional Code:   

 

Membership Information
If you are currently a member or would like to become a member fill out the information below.
I am currently a member of the North Suburban YMCA
Membership Type: 

OR
I would like to become a member of the North Suburban YMCA today
Membership Type:
  I am not interested in becoming a member of the North Suburban YMCA at this time.