CHRISTUS Swim Premium Application (REV 1-13-21)

2020-2021 Swim Season Premium Athlete Registration Application

Registered For USA Swim?
Swim Level
Set Up Recurring Billing To Pay Your Monthly Dues
Silver 1 Group Monthly Dues*
Price: $80.00
Price will be automatically charged monthly
Silver 2 Group Monthly Dues*
Price: $100.00
Price will be automatically charged monthly
Purple Group Monthly Dues*
Price: $120.00
Price will be automatically charged monthly
Billing Address*
Street Address Address Line 2 City State ZIP Code
Billing Party's Email Address*
USA Swim Registration Information
Name*
First Middle Last
Preferred Name
Date of Birth*
Date Format: MM slash DD slash YYYY
Sex*
- M
- F
Age
Pay Dues and Finalize Your Registration
I understand that my swimmer's monthly dues will be:
$0.00
Credit Card

Card Details

Cardholder Name