Candidate Information

Spouse/Spousal Equivalent/Significant Other Information

Dependants

(Unmarried children under the age of 21 or 23 attending college and residing w/ candidate)

References

Membership Information

I/We understand no portion of the Initiation Fee is refundable and this membership is nontransferable. * The “Initiation Fee” amount written above is the actual amount paid by Member (or if paying in installments, the amount required to be paid by Member) in United States dollars. The amount written above may be less than the Club’s current standard required initiation fee due to certificates, waivers or other special programs that have been applied to this membership. Refer to attached promissory note or addendum dated. for additional payments or conditions applicable to this Membership. **Applicable sales tax, if any, not included.

Associate Club Benefit Add-On

[Please Initial YES or NO]

Please enroll me/us in the Associate Club Benefits selected below. I/We have reviewed the terms and conditions of the benefits, and I/we agree to the terms and conditions. I/We understand that because I/we am/are choosing to enroll in the Associate Club Benefits at this time, the current upgrade fee(s) for the Associate Clubs Benefits selected below have been waived. I/We understand that I/we will be subject to payment of additional monthly dues in exchange for the Associate Club Benefits, which may be increased from time to time. I/We also agree to pay any charges I/we incur at the participating clubs upon receipt of my/our monthly statement. I/We further agree to conform to and be bound by the Bylaws and Rules and Regulations of the participating clubs, all of which may be amended or modified from time to time.
I/we am/are not interested in participating in upgraded Associate Club Benefits at this time. I/We understand that if I/we decide to participate in any available upgraded Associate Club Benefits in the future, I/we will be required to pay the current upgrade fee which is nonrefundable and subject to future increases. Membership currently provides the Associate Bronze benefit. We/I have reviewed the terms and conditions of the Associate Bronze benefit, and I/we agree to the terms and conditions. I/We also agree to pay any charges I/we incur at the participating clubs upon receipt of my/our monthly statement. I/We further agree to conform to add and be bound by the Bylaws and Rules and Regulations of the participating clubs, all of which may be amended or modified from time to time.

Payment of Membership Account

Payment of Membership Account, including all dues, fees and other applicable charges, is due upon receipt of the monthly statement. If accepted for membership, I/we agree to pay the account in full when due. I/We agree and understand that a late charge up to the maximum amount allowable by law, or other penalties, may be assessed for past-due accounts as provided for in the Bylaws and Rules and Regulations of the Club, as amended from time to time. In addition to late fees, penalties may include, but are not limited to suspension of Club privileges and/or expulsion from membership. Payments on delinquent accounts shall be applied first to reduce late charges, then to reduce accrued dues and food & beverage charges (with the payment applied to reduce the oldest past due balances first), and then to any other charges. Any fees assessed for untimely payment of any applicable dues, fees or charges will appear on my/our statement. I/We agree to pay all reasonable attorneys’ fees, investigator fees, and costs in the event this account is turned over for collection.
I/We would prefer Monthly Statements to be (select one)

Autopay – Autopay is the monthly automatic payment of your account balance by credit card. Please complete the Credit Card Authorization Form and submit with member contract.

Membership Policies

If accepted into membership, I/we agree to conform to and be bound by the enrollment terms contained herein, the Bylaws, the Rules and Regulations, and written membership policies of the Club (“Membership Documents”) as they may be amended from time to time. I/We further understand that agreeing to be bound by the Membership Documents is a part of my/our agreement for membership privileges with the Club. I/We specifically understand this membership is not divisible. I/We hereby acknowledge receipt of a copy of the Rules and Regulations of the Club.

I/we acknowledge the membership bylaws and the rules and regulations provide the details of the club’s membership policies, conduct and obligations, including, but not limited to, provisions in the event of divorce, for arbitration of disputes, resignation, redemption of memberships, financial obligations, disciplinary action, release of liability for personal injury and theft. I/we hereby fully release and discharge the club, it’s employees, agents, shareholders, members, managers, affiliates and assigns from any liability, injury, loss, damage or claim arising from my/our use of the club facilities.

If accepted into Membership in the Club, I/We "acknowledge" the charge of $1.25 a month for quarterly magazines, Private Club Magazine, to my membership. This monthly charge is subject to future increase at the discretion of the Club. This is a mandatory charge to your membership.

By providing the address(es) (including e-mail), phone numbers(s), and fax number(s) above, I/we hereby give the Club conditions of the Club’s Privacy Policy. I/We acknowledge that the Club values my/our right to privacy. I/We understand that I/we can revoke this consent at any time by contacting the Club in writing.

I/We agree to the terms and conditions of my/our membership may not be added to, amended, or contradicted in any way by evidence of prior, contemporaneous, or subsequent oral agreements of any kind and acknowledge there are no unwritten oral agreements of any kind. Member may resign by giving a 30 day written notice to Owner. Such a resignation shall be effective the first (1st) of the following month.

By signing below, we hereby certify that we hold a marriage license or a certificate to domestic partnership or civil union, which evidences our existing spousal relationship. If we do not hold on to any of the above, we acknowledge that the Club requires execution of a separate Spousal Relationship Statement.

I/We authorize Club to check my/our credit and employment history and to obtain such information, as Club deems necessary to accept my/our application and to extend credit to me/us under my/our membership account at the Club.

* Bold Fields are Required