Membership Application

Tampa Bay Area Grotto

Primary Member (Required)

Name
Email		Phone
Address
City	State		Zip
Date of Birth		NSS Member No.
Emergency Contact (Optional)
Many activities conducted by the Grotto are inherently dangerous. Please provide an emergency contact below. If you have any medical considerations, please speak with one of our officers privately so we can assist you. Medical information is kept strictly confidential.
Name		Phone
Family Members (Optional)
Please list contact information for each family member separately on the second page of this application. You may use as many additional pages as necessary.
Number of Family Members
Membership Dues
Dues are collected once per year. The cost depends on your level of membership in the Grotto. Associate: $20 per individual + $5 per family member; Full (NSS membership required): $10 for individuals, $15 for families residing in the same household. As a prospective member, you must attend a public Grotto event or meeting before your application will be considered. Please print this form to submit to a Grotto officer upon arrival. Payment instructions will be provided once your membership application has been approved.

Family Members (Use additional pages as necessary)

Name			Relation
Email			Phone
Date of Birth			NSS Member No.

Name			Relation
Email			Phone
Date of Birth			NSS Member No.

Name			Relation
Email			Phone
Date of Birth			NSS Member No.

Name			Relation
Email			Phone
Date of Birth			NSS Member No.

Name			Relation
Email			Phone
Date of Birth			NSS Member No.

Name			Relation
Email			Phone
Date of Birth			NSS Member No.

Name			Relation
Email			Phone
Date of Birth			NSS Member No.