Membership Waiting List Application
Thank you for your interest in membership at Peninsula Community Center. We currently have a waiting list for membership. Please fill out this form and Ebbi Vijeh, our Membership Coordinator, will contact you. If you have questions, please email Ebbi at firstname.lastname@example.org.
Which membership are you interested in?
Full Membership (tennis, swim & fitness)
Swim & Fitness
Masters (Masters swim program only)
Please check all that apply:
Adult + Adult Add-On
Adult + Adult Add-On 65+
Student (min 12 units, transcript required)
Primary Adult Name (Last, First)
Adult Add-On Name (Last, First)
Child 1 Name & Gender
Child 2 Name & Gender
Child 3 Name & Gender
Child 4 Name & Gender
How did you hear about us?
PCC Member (indicate below)
Other (indicate below)
If PCC Member or Other, name here:
What are your fitness interests?
I hereby agree that when I am contacted with an available membership, that I must complete a full application and submit applicable fees within 72 hours of notification or my place on the waiting list will be forfeited. All registration fees and dues at the time of joining will be applicable. Writing my full name below indicates my agreement with these statements.
Do Not Fill This Out