Mohican Swimming Pool Association Wait ListDate* MM slash DD slash YYYY Name* First Last Enter the name of the person who should be contacted if membership becomes available or with any questions regarding the wait list application.Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*Do You Own or Rent Your Home?* Own Rent Number of Adults Number of Children User Name* Please select a user name for your wait list account. You will be able to log in and check your status on the list as well as manage your wait list account with it. Password* Enter Password Confirm Password Strength indicator Select a password that you will use to access your wait list account. You will be able to send a password reset link to the email address you entered above if necessary.Application is hereby made for membership in Mohican Swimming Pool Association. If accepted, I agree to be responsible for full and timely payment of the equity fee (currently $3000, subject to change), annual dues, and any assessments established by the Board. I further agree that if offered a membership, I will either pay the then-official fee, or I will withdraw my application. This is only an application and membership is subject to the approval of the pool Board. I also understand that living within the geographic boundaries established by the pool is a requirement for remaining on the wait list. Finally, I understand that offers of swim privileges and other pool communications are made by email or telephone so I will be responsible for keeping my contact information up-to-date. If I cannot be reached it may impact my ability to receive swim privileges so I will contact Membership@MohicanPool.org to make updates.By checking this box I certify that the information is true and correct as of this date and I agree to the above terms and conditions.* Agree By checking this box I certify that the information is true and correct as of this date and I agree to the above terms and conditions.Wait List Fee* Price: Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name Total $0.00 CAPTCHA