Associate Member Application

Associate Member Application

"*" indicates required fields

MM slash DD slash YYYY
Billing Contact Name*
Enter the name of the person who should be contacted regarding any questions about the account.
Name of Associate Member Applicant:*
Name of Associate Member Applicant:
Address*
Associate memberships are only available to children of the regular member household that are over the age of 21, or a mother, father or mother-in-law or father-in-law not gainfully employed and living permanently with the regular member.
1. Identification:*
Accepted file types: jpg, jpeg, png, gif.
Please upload a photocopy of a picture identification for example a driver's license.
Max. file size: 10 MB.
Please provide two forms of proof of residency in the form of bills that include your address within the Pearl River Fire District or Pearl River School District. Examples include: tax bill, utility bill, water bill or phone bill.
Credit Card
American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Expiration Date
 
Associate Member Application fee: $100.00+ tax (8.375%)
Terms of Service*

Associate memberships are only available to children of the regular member household that are over the age of 21, or a mother, father or mother-in-law or father-in-law not gainfully employed and living permanently with the regular member.

This field is for validation purposes and should be left unchanged.
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