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Membership Application

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First Name

Last Name

Email

Phone

Street Address

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Region/State/Province

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Name, Age, Relation to member

Name, Age, Relation to member

Name, Age, Relation to member

Name, Age, Relation to member

Have you been a member of Poco before? *

Yep, I love Poco and I'm back for more!

Nope, but I'm excited to be here!

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Emergency Contact

Emergency Contact Phone

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Pocahontas Swim Club

Summer phone: (260)209-3158
Off Season phone: (260)450-2610

Email: pocoswimclub@gmail.com

Physical:

3020 Ojibway Trail

Fort Wayne, IN 46809

Mailing:

PO Box 11553

Fort Wayne, IN 46859

12:30 – 8:30 Daily, Memorial Day through Labor Day

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