Wait List Application I am applying for membership to Palisades Swimming Pool Association, Inc. I understand my name will be placed on the waiting list, and it is my responsibility to notify Palisades of any change in address. Billing Contact 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 AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Please keep in mind that the current wait time may be 8 to 10 years for members signing up today. We use email as the primary means of contacting members, so please use an address that will persist during that period.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. *NOTE: If you are already a member or on the wait list at another Member Splash club you will have to pick a unique username for this particular club.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.Account Members - AdultsNumber of Adults*12Adult 1* First Last Adult 1 DOB* Adult 1 Email* Adult 2* First Last Adult 2 DOB* Adult 2 Email* Account Members - ChildrenNumber of Children*012345Child 1* First Last Child 1 DOB* Child 2* First Last Child 2 DOB* Child 3* First Last Child 3 DOB* Child 4* First Last Child 4 DOB* Child 5* First Last Child 5 DOB* SignatureWait List Fee* Price: $40.00 If you are paying online you will be transferred to PayPal after hitting submit. It may take a few seconds to connect. Please only submit the form once. Submit This iframe contains the logic required to handle Ajax powered Gravity Forms.