Youth Membership Application Request

Child Information:

First Name *

Last Name *

Member Information

Primary Account Holder's Full Name: *

Member Number:

Phone Number: *

Upload Picture of Driver's License: *

Click or drag & drop image here to upload

Email: *

Child Information Continued:

Address: *

City: *

Zip *

Date of Birth: *

Gender:

Male

Female

Upload Picture of Social Security Card: *

Click or drag & drop image here to upload

Thank you for submitting your Youth Membership Application.

An Affinity Financial Service Representative will be contacting you within the next business day.

All requests are processed during normal business hours in the order they are received.