JoinName(Required) First Last Membership(s)(Required)Single ($65)Double ($100)Family ($125)Email(Required) Phone(Required)Address(Required) Street Address Address Line 2 City StateAlabamaAlaskaAmerican 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 Credit Card(Required)Date(Required)CVV(Required)Agreement(Required) By checking this box, I confirm that I have read and understood this consent agreement.I hereby acknowledge and consent to the following: I authorize Pulaski County Parks & Rec to collect, store, and process my personal information, including my name, email, phone number, address, and payment details, for the purposes of setting up and managing my Brazilian Jiu-Jitsu membership. I authorize Pulaski County Parks & Rec to charge the provided payment method for membership fees and any applicable recurring charges as outlined in the membership agreement. I understand that all personal and payment information will be handled in accordance with Pulaski County Parks & Rec's Privacy Policy and applicable laws. I agree to the terms and conditions of membership and acknowledge that I have reviewed and accept Pulaski County Parks & Rec's cancellation and refund policies. I acknowledge that I will receive an email about my account and membership and understand that I may cancel at any time.CommentsThis field is for validation purposes and should be left unchanged.