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CSIndy Membership Request Form

Fill out the form below and click the Continue button at the bottom.

This is where we gather all the important information we'll need to have on file for you and your student(s). You will need your insurance card & doctor's information. This form does not auto save & needs to be completed in one sitting so wait until you have 10-15 minutes to fill it out without interruptions. Registration fees will need to be collected before approving membership.

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Upload Family Photo (Optional) .jpg, .gif or .png

Children

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Payment Instructions

You will be sent an invoice for the registration fee amount of $99 per child being registered. Thank you!