Membership Household Change Request Use to request addition or deletion of a Club Member* from membership household This field is hidden when viewing the formAcct #*Please remember, "Club Member" is formally defined in our Aqua Club Bylaws, Section 2.2.1, and includes the following persons living at the same permanent address: The individual named in the certificate of Club Membership, His or her spouse residing in the same house, and Each dependent child residing in such individual's house. A dependent child away from the house attending school or for military service will still be considered part of the household if they still customarily live in the household. But a married child living in a household is not considered a dependent and must apply for a separate membership to use the club. It is each member’s responsibility to accurately identify Club Members and update Aqua Club of changes to Club Members in a household. Failure to comply with Aqua Club Bylaws or other rules and regulations, including identifying persons as Club Members who are outside the definition in the Aqua Club Bylaws, may result in suspension and/or expulsion and forfeiture of membership.Primary Accountholder Name(Required)Primary Account Holder Email(Required) Primary Account Holder Birthdate(Required) MM slash DD slash YYYY Address(Required) Street Address Address Line 2 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 Phone(Required)Primary Account Holder Picture (required if not already in the system)(Required)Max. file size: 5 MB. NAME, BIRTHDATE, AND PHOTO are REQUIRED for each household memberType of Household Member #1(Required) Dependent Spouse Name #1(Required)Birthdate #1(Required) MM slash DD slash YYYY Picture #1Max. file size: 5 MB. Type of Household Member #2 Dependent Spouse Name #2Birthdate #2 MM slash DD slash YYYY Picture #2Max. file size: 5 MB. Type of Household Member #3 Dependent Spouse Name #3Birthdate #3 MM slash DD slash YYYY Picture #3Max. file size: 5 MB. Type of Household Member #4 Dependent Spouse Name #4Birthdate #4 MM slash DD slash YYYY Picture #4Max. file size: 5 MB. Indicate the Club Member you would like to remove from your household membershipPlease list additional email address(es) to include, if any, and for which memberOther Relevant Information/Change RequestsPhoneUntitledRemember to include NAME, BIRTHDATE, AND PHOTO for EACH household memberOrder Token