Become A Member

"*" indicates required fields

Name*

First Last

Email*

Password*

Enter Password Confirm Password

This is the password used to register for classes and check your account.

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Emergency Contact Information*

Please include the name and contact phone number/s for your emergency contact.

FOR FAMILY MEMBERSHIP ONLY

Please list the first and last name, phone number, and email address of the second member.

Life Enrichment Center Membership*

Yearly Individual Membership

Yearly Family Membership (2 people)

Total

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