Arc Achievers

2015
Membership Enrollment Form
General Information

Date:

Name of program participant:

Address:
Home#

Cell#

Email:

Name of Parent / Guardian:

Parent cell phone/email:
Name and phone number of one (1) back up person who may be contacted in case of emergency
(must be other than parent / guardian):

Below please indicate which type of membership you are selecting. Arc Achievers membership runs
from 7/1/15 - 6/30/16:
____Standard membership ($30) This membership is our standard savings plan. It entitles the member to Arc
Achievers prices when purchasing tickets to recreation events throughout the year.
____Plus Membership ($50)This membership come with all the benefits of a Standard membership, PLUS
each member will receive a free member only catered dinner in the Spring of 2016 and a $5 coupon to use
on our PODS transportation system
____Group Membership ($150)This membership come with all the benefits of a plus membership. In addition it is valid for up to four(4) people per event, and is valid for up to 4 individuals at our catered
membership dinner. It also includes 4, $5 coupons to ride the PODS transportation system. Perfect for
organizations and families.
Method of Payment:

Check

Check #

Credit Card

Credit Card Type

Credit Card number
Exp Date

For Questions, please contact Recreation Manager Drew Zimmerman at 609-406-0181 x101 or
dzimmerman@arcmercer.org
Please return Enrollment Forms to Drew Zimmerman at 180 Ewingville Rd, Ewing, NJ 08638