Merrimack Pool | Full Summer Affiliate Application

Complete this form and submit the non-refundable $50 application fee to apply for Full Summer Affiliate swim privileges at Merrimack Pool.

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Payment Status
Account Types
Name*
First Last
Your membership will be initiated under this family name.
# of Household Members*
Household members include spouses, children or others living with you.
Address*
Street Address City State ZIP Code
Do You Live Within Merrimack Pool Boundaries?*
- Yes
- No
Please indicate whether you live within the boundaries of Goldsboro Rd (S), MacArthur Blvd (W), Wilson Lane (N) and River Road (E). Merrimack Pool gives preference to applicants who reside in neighborhoods surrounding the pool, if they apply for Equity Membership (only).
Phone*
Cell Phone*
Email Address*
Password*
Enter Password Confirm Password

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How Did You Learn About Merrimack Pool?
We would like to say "thank you" for a referral or recommendation.
Full Summer Wait List Application Fee*
Price:
There is a one-time, non-refundable wait list fee.
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name