2. 

3. ADULT ACTIVITY CENTER REGISTRATION FORM

   Use this form if an activity, class, trip or event organized by the Adult Activity Center requires registration. Payment for fees are accepted via cash, check, or credit/debit card (3% fee to use a card), by US Mail or stopping by the Adult Activity Center, 506 S. Pine

5. Registration date
   Registration date
   Some events, classes, trips or activities have a limited number of spaces. Applications are processed on a first come, first serve basis.
7. INFORMATION ABOUT YOU
9. First Name
10. Last Name
12. Address1
14. City
15. State
16. Zip
18. Email address
19. Daytime phone number
21. REGISTRATION INFORMATION
23. NAME OF THE TRIP, ACTIVITY, CLASS OR EVENT
25. Enter the DATE (mm/dd/yyyy) of the activity you are registering for
26. Enter the START TIME of the activity you are registering for
28. INFORMATION ABOUT PAYING ACTIVITY FEES

    AAC users may pay a $45 annual fee, or attend activities as a non-user. Some activities have a fee associated with them. Two levels of fees may apply: user (this is for AAC members) and non-user (this is for non-members). Payment of any fees is done by US mail or at the AAC, 506 S. Pine, Monday-Friday, 8AM-4PM (except holidays) via cash. check in advance of the activity or credit/debit card (there is a 3% fee when using a card). Check activity flyer for registration deadlines or call (509) 962-7242.

30. HAVE QUESTIONS OR NEED MORE INFORMATION?
    Stop by the Adult Activity Center (AAC) Monday - Friday, 8AM-4PM (except holidays) or give us a call at (509) 962-7242.
Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field