ORCAS ATHLETICS, BRS, Ltd.
P.O. Box 786 Eastsound, WA 98245
Office: 360.376.6361 Fax: 360.376.6365 www.orcasspaandathletics.com
MEMBERSHIP CHANGES/UPDATES

I request that the following changes be made to my membership.

Name: __________________________________________________________________

Local Mailing Address: ____________________________________________________

Phone number: ___________________________________________________________

Email Address:___________________________________________________________

Payment Method: _________________________________________________________
(Include voided check or credit card imprint)
Expiration Date:_______________

Membership Upgrade: _____________________________________________________

Locker Rental: ___________________________________________________________

(For any changes not noted on this form, please see the manager.)



____________________________________________ __________________
Member Signature Effective Date

____________________________________________
Print Name




For Office Use Only

Note: Please staple necessary receipts, voided c/c imprint or check, to this form.

Received By__________________________________

Date Received ________________________________

Authorized By ________________________________

Notes: