2019 Renewing Non - Resident Application

Size: px
Start display at page:

Download "2019 Renewing Non - Resident Application"

Transcription

1 2019 Renewing Non - Resident Application Rye Golf Club 330 Boston Post Road ~ Rye, NY ~ ~ RYE GOLF CLUB APPLICATION PROCESS FOR RENEWING NON RESIDENT MEMBERS RESIDENCY REQUIREMENTS Residency is defined as having your primary residence (legal domicile) solely within the physical boundaries of the City of Rye. Ownership of real property within the City or a mailing address may not constitute residency. (2) Required Documents: A current utility bill and driver s license ONLY. Additional documents or verification must be presented if required by management. Documents must show applicants name and current address. The burden of establishing proof of residency to the satisfaction of Club Management shall be upon the applicant. INSTRUCTIONS: Read all enclosed information prior to completing application process. Select category of membership requested, complete and sign membership application. Select payment option: One Time Payment by Check or Credit Card*, Or a credit card installment plan*. *Additional Fees Apply Member Services must receive all documents and payments by March 15 th (except pool only memberships are due by May 10 th ) otherwise the renewing member discount will not be available. Only completed applications with all required documents will be processed. Incomplete applications, missing documents or payments not submitted before the deadline will result in the loss of renewing membership discount and may impact membership eligibility. If a new child has been added to the membership, please provide a copy of birth certificate or passport. The Club is not responsible for non-delivery or postal delays. Once your payment is processed, there will be no refunds. The enrollment process may take up to five business days. MEMBER INFORMATION AND ADDITIONAL FEES Consult Member Handbook (available on the club website or in hard copy at the membership office) for complete description of membership categories, restrictions, age requirements, rules, and policies. Refer to additional services flyer for additional services and membership add-ons. PAYMENT INFORMATION Rye Golf Club is a cashless club. Payment of guests and other applicable services, fees, or products purchased must be settled through your established member charge. All returned checks are subject to a transaction fee. For NEW MEMBERS, upon acceptance of membership, your payment will be processed as specified on your application and you will be notified of your acceptance. MEMBERSHIP CATEGORY CHANGE FOR RENEWING MEMBERS ONLY The Club is under no obligation to make a change to a member s membership category. Membership category changes are completed through a selection process on a space available basis. You will automatically be assigned to the same category as last season if not specified. If you are selected for a category change, your account will be automatically charged for the difference (if a credit is due, the balance will be placed in a credit account for your use at the club) and you will be notified as to the change. Once a change has been processed, the change is final. NOTE: If you wish to withdraw your application, it must be done in writing by certified mail and postmarked within three calendar days from the date application was received.

2 Membership Information (Non - Resident Application) THIS APPLICATION MUST BE FILLED OUT IN ITS ENTIRETY OR IT WILL NOT BE ACCEPTED. This application is valid for the current membership year only. Primary Member Number Membership Category Last Name First Name Birth Date If all the information previously given in 2018 has remained the same please check the box and complete the payment information below. If changes to your family or contact information have occurred please fill out page 3. By checking this box I confirm that my contact and personal information has not changed since 2018 By checking this box I wish to opt out of displaying my contact information in the member directory PAYMENT OPTIONS (Please Check One) Early Enrollment Deadlines (Golf & Comprehensive March 15 th Pool May 10 th ) Primary Category Fee Schedule Located On page 3 $ 1. Payment in full by Check Please make check payable to Rye Golf Club 2. Payment in full by Credit Card (Subject to an additional 2.65 percent fee from GovPayNet, charge will appear as GPS City of Rye ) Additional Memberships Fee Schedule Located On Page 3 $ 3. Installment plan by Credit Card (All installment payments will incur a $20 convenience fee) Applications must arrive PRIOR to March 15 th to be eligible for all 5 installments on Golf or Comprehensive memberships. Applications must arrive prior to May 10 th to be eligible for all 3 installments on Pool memberships. Non Res City Surcharge Total Due $ $75 Golf March 15 th April 10 th May 10 th June 10 th July 10 th - - May 10 th June 10 th July 10 th Pool *Members who join after 3/15 will be billed in a fewer number of equal payment installments, depending on the date joined. Installments will be billed through July, commencing on the first full month after you join. MANDITORY credit card information for member charge account and/or installment plan payments is required. Circle Type: AMEX MC VISA DISCOVER CVV Code: Month Card # Exp / Year Payment of guests, carts, and other services purchased must be settled through your established member charge account. I authorize Rye Golf Club (the Club ) to charge my credit card provided by me for payment of all applicable services, products, or fees for myself, family listed on my account, guests brought to the club, or child care providers listed on my account unless otherwise stated. I will notify the Club immediately of any changes to my credit card account such as a new expiration date, a lost or stolen card or closing of an account and will provide new or updated credit card information. If my account is past due for any reason my membership and/or charging privileges may be suspended until the account is settled. If the account is 30 days past due a 5% monthly service charge will be added. I further understand that if I do not have a valid member account I have no guest or charging privileges. I understand the Club reserves the right to adjust fees and schedules and can close the facilities for any reason without granting any refunds. I also understand the Club has a no refund policy that is strictly enforced. I recognize and acknowledge that there is risk of injuries, damage, or loss to person or property which may be sustained as a result of use of the Club facilities and I agree to waive and relinquish all claims and hold harmless the City of Rye, Rye Golf Club, its officers, agents and employees from any and all claims. I certify that all statements and entries made on this application form and any documents submitted in support thereof are true. I certify that all members listed on this application have read and/or understand the current Member Handbook (available on club website or hard copy at the membership office) and agree to act in strict accordance with the rules and policies set forth by the Club including any revisions made thereto. Failure to comply with the aforementioned may result in suspension or revocation of membership privileges without refund of any fees paid. Any misrepresentation, fraudulent statement or fraudulent document will result in termination or denial of membership without refund of fees paid and will be prosecuted to the fullest extent permitted by law. I hereby grant to the City of Rye, the Rye Golf Club, its officers, agents and employees, the irrevocable and unrestricted right to use and publish photographs and/or videos of me (and any other member listed on this membership application) or in which I (and any other member listed on this membership application) may appear for advertising and promotional purposes and in any manner and medium and to alter same without restriction. Name: X Print Primary Member Date Signature

3 Page 3 Renewal Information update form. Fill out ONLY if your information has changed. Primary Member Last Name First Name Birth Date Street Address City State Zip Home Phone Cell Phone Primary Spouse/Secondary Spouse Secondary Cell Phone Membership Category(s) Requested Additional Members on Account First Name Last Name Birth Date Gender (Spouse) Renewing by March 15 th After March 15th Comprehensive $8,160 $9,660 Individual Daily Golf $5,715 $6,765 Individual Weekday Golf* $3,470 $4110 Young Executive $3,415 $3,415 Renewing By May 10 th Family Pool $2,550 $3,020 Individual Pool $1,225 $1,450 Pool for Two $2,245 $2,470 House $450 $450 All membership categories are defined in the handbook. All non-resident accounts are charged a $75 surcharge by the City of Rye Non - Resident Fee Schedule After May 10th *Weekday memberships are available to renewing weekday members

4 Add ons and Additional Services Last Name First Name Member Number_ Instructions: Please check off items that you would like to add to your membership. Total the amount due to the club, select payment type, sign the sheet and return to the membership office. Golf Lockers $150 Renew Golf Locker Men s Renew Golf Locker Ladies Request Golf Locker Men s * Pool Lockers $35 Men s Pool Locker Ladies' Pool Locker Request Golf Locker Ladies * *Lockers are on a first come/first serve basis and charges for new lockers will not be applied until one is selected for you. Add Ons Child Care Provider $425 Golf Add On $200 Allows for two rounds of golf for Last Name First Name pool members. Pool Add On $25 Street Address City State Allows for two pool visits for golf members. Zip Birth Date Phone Number Early Morning Lap Swim $200 Available for pool and comprehensive memberships only. Valid ID Required ADD ON MEMBERSHIP Child Care Provider (CCP): Available with Comprehensive or Family Pool membership only. Required for Comprehensive or Family Pool members that would like their own Child Care Provider to accompany the member s child or children to the pool. CCP has no membership privileges and may not use facilities unless accompanied by member s children. CCP may not bring guests to the facility. CCP is not transferable from one CCP to another and the CCP must be named at the time of registration. Payment Options Member Charge Total Check Signature

5 Rye Golf Club Membership Dues Payment Options BY CREDIT CARD Rye Golf Club members are now able to pay in full by the convenience of their credit card. Please fill out your application completely and prepare proof of residency if you are applying for a Rye Resident Membership. If you wish to pay in person you may return your application to the membership office in person during regular business hours. A credit card processing fee of 2.65 percent will be collected by the credit card processor. The charge will appear on your statement as GPS City of Rye INSTALLMENT PLAN Please refer to the application for complete details on the installment plan offered by Rye Golf Club. Please fill out your application completely and prepare proof of residency if you are applying for a Rye Resident Membership. Comprehensive and Golf Membership Installment plan payments will be run on March 15th, April 10th, May 10th, June 10th, and July 10th. Members signing up prior to March 15th will be eligible to split their membership dues over 5 credit card payments. Pool members signing up before May 10th will be eligible to split their membership dues over 3 credit card payments May 10th, June 10th, and July 10th. All installment plan transactions will incur a $20 convenience fee from Rye Golf Club. BY CHECK Please fill out your application completely and prepare proof of residency if you are applying for a Rye Resident Membership. Refer to your 2019 Membership application included in this package for your 2019 dues. Remember, that a Credit Card will need to be kept on file for your membership charge account.

6 Options For Returning Your Completed Application Delivery In Person To the RGC Membership Office Monday - Friday 9 AM until 5 PM ~ Scan & Your Completed Application to Office@ryegolfclub.com ~ Mail Your Completed Application to the Golf Club 330 Boston Post Rd, Rye NY If your referral leads to a Young Executive Membership, you will receive $125 in RGC Member Rewards

7 Members; In an effort to be environmentally conscientious we have not mailed out copies of our handbook this year. The handbook is available on the membership webpage (please refer to the printed instructions). We strongly encourage all returning members to review the policies and guidelines in the membership handbook by viewing it online. If you would like a copy in print please feel free to contact the membership office ( or Membership@ryegolfclub.com) to have one mailed to you or ed to you. Additionally, copies in print are available at the membership office from 9am until 5pm Monday through Friday as well as weekends March through September. Please click this link Please contact us if you require assistance logging onto our membership to download the handbook.

8 2019 Pool Saturday May 25 th through June 9 th 10:00 AM until 7:00 June 10 through August until August 19 th through until The Club may shut all or parts of the pool facility down without notice for maintenance, staffing concerns, or related

2018 Renewing Resident Application. Rye Golf Club 330 Boston Post Road ~ Rye, NY ~ ~

2018 Renewing Resident Application. Rye Golf Club 330 Boston Post Road ~ Rye, NY ~ ~ 2018 Renewing Resident Application Rye Golf Club 330 Boston Post Road ~ Rye, NY 10580 ~ 914-835-3200 ~ www.ryegolfclub.com RYE GOLF CLUB APPLICATION PROCESS FOR NEW AND RENEWING RESIDENT MEMBERS RESIDENCY

More information

BROOKSVILLE GOLF & COUNTRY CLUB APPLICATION FOR MEMBERSHIP

BROOKSVILLE GOLF & COUNTRY CLUB APPLICATION FOR MEMBERSHIP BROOKSVILLE GOLF & COUNTRY CLUB APPLICATION FOR MEMBERSHIP Welcome to Brooksville Golf & Country Club (BGCC). Please complete the following application and member information form as thoroughly as possible.

More information

2019 EBENSBURG COUNTRY CLUB MEMBERSHIP AGREEMENT

2019 EBENSBURG COUNTRY CLUB MEMBERSHIP AGREEMENT 2019 EBENSBURG COUNTRY CLUB MEMBERSHIP AGREEMENT This Packet includes the following: 1. Membership Agreement - Must be completed 2. New member contact Information - Must be completed to get discount 3.

More information

2018 MEMBERSHIP OPTIONS

2018 MEMBERSHIP OPTIONS 2018 MEMBERSHIP OPTIONS Unlimited Allows the designated Member (or couple) unlimited golf play seven days per week. Tee times may be made up to 14 days in advance. Weekday Plus Allows the designated Member

More information

Visionary Preview Program

Visionary Preview Program Visionary Preview Program The Basics Extend an invitation Thank You Rewards Current members are encouraged to be ambassadors of Hillcrest and promote our club. The incentive is for these members to receive

More information

Country Club of Culpeper

Country Club of Culpeper Welcome to Country Club of Culpeper 2100 Country Club Road Culpeper, VA 22701 540.825.1746 Jen Sandy, Membership & Events Director Jsandy@countryclubofculpeper.com Country Club of Culpeper CLUB HOUSE Grill

More information

An Exclusive Recreational Membership

An Exclusive Recreational Membership An Exclusive Recreational Membership LOCATION: 20 Elm Street (Route 62) North Reading, MA 01864 GENERAL OFFICES: Mail all correspondence to 149 S. Main Street Middleton, MA 01949 978-646-1111 Option 2,

More information

BRETTON WOODS CLUB Membership Application

BRETTON WOODS CLUB Membership Application BRETTON WOODS CLUB Membership Application Primary Member s Name Spouse s Name Birth Date Birth Date Home Address Local Address Email Address Please check box if you do NOT wish to receive eclub news and

More information

Membership Offerings TRANSITIONAL MEMBERSHIP FULL GOLF MEMBERSHIP SOCIAL MEMBERSHIP (LIMITED AVAILABILITY) SPORTS MEMBERSHIP CLUBHOUSE MEMBERSHIP

Membership Offerings TRANSITIONAL MEMBERSHIP FULL GOLF MEMBERSHIP SOCIAL MEMBERSHIP (LIMITED AVAILABILITY) SPORTS MEMBERSHIP CLUBHOUSE MEMBERSHIP 2 1 7 9 B a h a m a R o a d, Membership Offerings FULL GOLF MEMBERSHIP INITIATION FEE $4,000 (non-refundable) MONTHLY DUES $445 family/$330 single DINING MINIMUM $60/month family or $40/month single PRIVILEGES

More information

DANVILLE FAMILY YMCA SCHOLARSHIP APPLICATION

DANVILLE FAMILY YMCA SCHOLARSHIP APPLICATION DANVILLE FAMILY YMCA SCHOLARSHIP APPLICATION 1 This is an application for financial aid toward YMCA membership and program fees. Please note that applying for financial assistance does not mean you will

More information

APPLICATION FOR MEMBERSHIP

APPLICATION FOR MEMBERSHIP APPLICATION FOR MEMBERSHIP Membership Desired Regular Golf Junior Golf Non-Resident Tennis THE LAKEWOOD CLUB TERMS AND CONDITIONS FOR MEMBERSHIP APPLICATION By signing The Lakewood Club Membership Application

More information

APPLICATION FOR MEMBERSHIP PRIVILEGES

APPLICATION FOR MEMBERSHIP PRIVILEGES The undersigned hereby applies for a membership at Spring Creek Golf Club. If approved, the undersigned requests that his/her name be placed on the Membership Roster as follows. MEMBERSHIP INFORMATION

More information

North Carolina Application for Dental Insurance

North Carolina Application for Dental Insurance Section A. Dental Coverage Options: 1. Select who the coverage is for: Primary Applicant Only Primary Applicant and Dependent(s) Child(ren) Only 2. Select what coverage applicant(s) is/are applying for:

More information

MARYLAND GOLF. and Country Clubs Application for Membership East MacPhail Rd Bel Air Maryland

MARYLAND GOLF. and Country Clubs Application for Membership East MacPhail Rd Bel Air Maryland MARYLAND GOLF and Country Clubs Application for Membership 1335 East MacPhail Rd Bel Air Maryland 21015 410-879-2025 www.marylandgcc.org 1 Category Pricing Current Initiation Fee Monthly Dues Food Minimum

More information

The DuPont Country Club 2018 Membership Application

The DuPont Country Club 2018 Membership Application APPLICANT NO. 1 The DuPont Country Club 2018 Membership Application For questions, call the Membership Office at (302) 421-1722. PRICES ARE SUBJECT TO CHANGE WITHOUT NOTICE. APPLICANT INFORMATION OFFICE

More information

Membership Application

Membership Application Membership Application 25 Club Road Newton, NJ 07860 (973) 383-4817 www.newtoncountryclub.org Type of Membership Desired Check One: Membership Category Pre-Paid Golf Member Dues Total Dues -25% Discount

More information

BE A PART OF SOMETHING GREATER Membership Application BRAD AKINS BRANCH

BE A PART OF SOMETHING GREATER Membership Application BRAD AKINS BRANCH BE A PART OF SOMETHING GREATER Membership Application BRAD AKINS BRANCH YMCA Mission: To put Christian principles into practice through programs that build healthy spirit, mind, and body for all. Because

More information

2019 MEMBER APPLICATION PACKAGE

2019 MEMBER APPLICATION PACKAGE 2019 MEMBER APPLICATION PACKAGE SPECIAL OFFERS * MEMBER APPRECIATION DISCOUNT * Prior Year Members in Good Standing will Receive 5% Off All Selected Tailored Programs Discount Expires on February 28, 2019

More information

Membership Application

Membership Application Membership Application Founder Active Associate Racquet Riding Boarding Member Riding Member (no horse) Lesson Program Name of Applicant: Date: Home Address: City: State: Zip: Billing Address (if different

More information

2017 SUMMER DANCE PROGRAM NEWTON REGISTRATION AGREEMENT

2017 SUMMER DANCE PROGRAM NEWTON REGISTRATION AGREEMENT Student ID: (Office use only) Parent ID: (Office use only) 863 Washington Street, Newtonville, MA 02460 SDP@bostonballet.org 2017 SUMMER DANCE PROGRAM NEWTON REGISTRATION AGREEMENT This form must be accompanied

More information

MEMBERSHIP AGREEMENT

MEMBERSHIP AGREEMENT MEMBERSHIP AGREEMENT Applicant understands and agrees that the General Terms and Conditions of Membership are a part of this agreement. Enrollment Date: Member Name: Initiation Fees: Club Name: Membership

More information

Enrollment Agreement - Page 1

Enrollment Agreement - Page 1 1414 Walnut St., Berkeley, CA 94709 5811 Racine St, Oakland, CA 94609 Ph: 510-848-0237 Fax: 510-848-0170 Ph: 510-595-9222 Fax: 510-595-9223 JCC OAKLAND AFTERSCHOOL 2018-2019 SCHOOL YEAR Enrollment Agreement

More information

THE CLUB AT BELLA COLLINA MEMBERSHIP AGREEMENT INVITATIONAL MEMBERSHIP. Member Initial

THE CLUB AT BELLA COLLINA MEMBERSHIP AGREEMENT INVITATIONAL MEMBERSHIP. Member Initial THE CLUB AT BELLA COLLINA MEMBERSHIP AGREEMENT INVITATIONAL MEMBERSHIP I. INFORMATION Please provide the following information for our files and records: PERSONAL Member s Name: Email Address: Birthdate:

More information

BUSINESSMAX MEMBERSHIP APPLICATION

BUSINESSMAX MEMBERSHIP APPLICATION One Leo Fraser Dr., Northfield, NJ 08225 ottingergolf.com Atlantic City CC: 609-236-4400 Ballamor GC: 609-601-6220 Scotland Run GC: 856-863-3737 BUSINESSMAX MEMBERSHIP APPLICATION Company Name: Business

More information

MEMBERSHIP CONTRACT GENERAL APPLICATION INFORMATION MONTHLY DUES (PAID IN ADVANCE) $ 15.OO 1. MEMBERSHIP TYPE(S) AND DUES TOTAL DUE TODAY $ START DATE

MEMBERSHIP CONTRACT GENERAL APPLICATION INFORMATION MONTHLY DUES (PAID IN ADVANCE) $ 15.OO 1. MEMBERSHIP TYPE(S) AND DUES TOTAL DUE TODAY $ START DATE GENERAL APPLICATION INFORMATION MEMBERSHIP CONTRACT NAME EMAIL SOCIAL SECURITY NUMBER EMPLOYER OF BIRTH EMERGENCY CONTACT NAME SPOUSE S NAME (IF APPLICABLE) EMERGENCY CONTACT PHONE ADDRESS NAMES ON CONTRACT

More information

Walter F. Ehrnfelt Recreation Center Royalton Road, Strongsville, Ohio

Walter F. Ehrnfelt Recreation Center Royalton Road, Strongsville, Ohio Annual Membership Packages for the Walter F. Ehrnfelt Recreation Center 18100 Royalton Road, Strongsville, Ohio 44136 440.580.3260 www.strongsville.org Fees effective as of October 1, 2014 You now have

More information

FLYERS AFTER SCHOOL PROGRAM APPLICATION FOR CHILD. Childs Information. Date of Application: Child s Name (first & last name)

FLYERS AFTER SCHOOL PROGRAM APPLICATION FOR CHILD. Childs Information. Date of Application: Child s Name (first & last name) FLYERS AFTER SCHOOL PROGRAM 2014-2015 APPLICATION FOR CHILD *All information must be complete in order to enroll Childs Information Child s Name (first & last name) Name of School and Grade Date of Birth

More information

Country Club of Culpeper Application for Membership PERSONAL

Country Club of Culpeper Application for Membership PERSONAL Application for Membership PERSONAL Name Mr. Mrs. Ms. Street Address City State ZipCode Telephone Home: Work: Email: Date of Birth Social Security No. Spouse s Name Mr. Mrs. Ms. Date of Birth Social Security

More information

Name: DOB: Relationship: Name: DOB: Relationship: Name: DOB: Relationship: Name: DOB: Relationship: Name: DOB: Relationship:

Name: DOB: Relationship: Name: DOB: Relationship: Name: DOB: Relationship: Name: DOB: Relationship: Name: DOB: Relationship: Member Information Applicants Name: Co-Applicants Name: Membership Application Please read and complete thoroughly all fields and pages of the application. Incomplete applications will be returned to the

More information

Studio Policies

Studio Policies 2018-19 Studio Policies Welcome to EXPRESS Dance & Acrobatics. Our mission is to teach the fundamentals of dance and acrobatics, with an emphasis on commitment, education, safety, and fun in a healthy

More information

STUDENT REGISTRATON. Emergency Contact: Medical conditions / allergies: Yes No If yes, please explain: Parent/Guardian's Signature:

STUDENT REGISTRATON. Emergency Contact: Medical conditions / allergies: Yes No If yes, please explain: Parent/Guardian's Signature: STUDENT REGISTRATON Student's Name: Age: Male/Female: of Birth: / / Are you a returning Footworks student (Y/N)? Years dance experience: E-mail address: How did you hear about us? (circle) WO TIMES-SW

More information

REGISTRATION FORM. NAME: or Business: ADDRESS: CITY: STATE: ZIP: HOME PHONE: CELL PHONE: TODAYS DATE:

REGISTRATION FORM. NAME: or Business: ADDRESS: CITY: STATE: ZIP: HOME PHONE: CELL PHONE:   TODAYS DATE: REGISTRATION FORM NAME: or Business: ADDRESS: CITY: STATE: ZIP: HOME PHONE: CELL PHONE: EMAIL: TODAYS DATE: I, have read and understand the rules and regulations set forth by Acme Auto Auction Inc as stated

More information

Membership Options /$95 Enrollment Fee (Check One)

Membership Options /$95 Enrollment Fee (Check One) Membership Options /$95 Enrollment Fee (Check One) 12 Month Contract 1 Person 2 People 3+ People Single Membership Couple Membership Family Membership 4+Open Gym $48 (4 Sessions) $80 (8 Sessions) $110

More information

Recreational Dance & Acrobatic Class Policies

Recreational Dance & Acrobatic Class Policies 2016-2017 Recreational Dance & Acrobatic Class Policies Welcome to EXPRESS Dance & Acrobatics. Our mission is to teach the fundamentals of dance and acrobatics, with an emphasis on commitment, education,

More information

MIAMI ROWING & WATERSPORTS CENTER, INC Membership (6 pages) Application For:

MIAMI ROWING & WATERSPORTS CENTER, INC Membership (6 pages) Application For: MIAMI ROWING & WATERSPORTS CENTER, INC. 2017 Membership (6 pages) Application For: FAMILY MEMBERSHIP: Initiation Fee: $500.00 Monthly Dues: $110.00 Annual Due $1320.00 Equipment Fund Monthly Due $15.00

More information

additional $785 additional $390 additional $195

additional $785 additional $390 additional $195 ADDITIONAL PRIVILEGES Also available to our Members are facility rentals, access to most JCCs nationwide, member-only publications, priority registration, membership discount on programs and so much more!

More information

YMCA AFTER SCHOOL CARE REGISTRATION PACKET

YMCA AFTER SCHOOL CARE REGISTRATION PACKET YMCA AFTER SCHOOL CARE REGISTRATION PACKET 2016-2017 Welcome! We look forward to having your family join us in the YMCA After Care Program! Sarah Kim Child Care Director 734.661.8058 skim@annarborymca.org

More information

Saturday 9:00 am 11:30 am

Saturday 9:00 am 11:30 am Healthy Body, Healthy Mind Monday Thursday 6:00 pm 8:00 pm Saturday 9:00 am 11:30 am ** s and times are subject to change due to high school & school district events Waiver and Release: WATERVLIET HIGH

More information

2019 Nashville Pilot Camp Registration

2019 Nashville Pilot Camp Registration 2019 Nashville Pilot Camp Registration Camp Information The following pages contain the registration form, code of conduct, and all medical paperwork to be filled out. Be sure to fill these out and mail,

More information

Continue your Aetna life insurance coverage with these options.

Continue your Aetna life insurance coverage with these options. Aetna Life Insurance Company PO Box 14418 Des Moines, IA 50306-3418 Phone: 1-800-882-8395 Fax: 1-515-330-3296 Continue your Aetna life insurance coverage with these options. Thank you for your interest

More information

National Electrical Annuity Plan Disability Benefit Application

National Electrical Annuity Plan Disability Benefit Application National Electrical Annuity Plan Disability Benefit Application To avoid delays in the processing and payment of your benefit, please follow these instructions carefully and completely. 1. Print all information

More information

HELPING TEENS THRIVE. Youth & Government CENTRAL YMCA

HELPING TEENS THRIVE. Youth & Government CENTRAL YMCA HELPING TEENS THRIVE Youth & Government CENTRAL YMCA LEARN MORE WHAT IS YOUTH & GOVERNMENT? Learn first-hand how our state government works not by watching, but by doing! Each September for six months,

More information

Group Enrollment Processing. In order to ensure proper processing of your applications, please read the following instructions carefully.

Group Enrollment Processing. In order to ensure proper processing of your applications, please read the following instructions carefully. Dergalis ASSOCIATES Group Enrollment Processing In order to ensure proper processing of your applications, please read the following instructions carefully. 1) Once you have selected the plan(s) in which

More information

MEMBERSHIP APPLICATION WE RE A CAUSE WE RE MORE THAN A GYM. YMCA of Broome County

MEMBERSHIP APPLICATION WE RE A CAUSE WE RE MORE THAN A GYM. YMCA of Broome County MEMBERSHIP APPLICATION WE RE MORE THAN A GYM WE RE A CAUSE YMCA of Broome County MEMBERSHIP RATES Membership Type Monthly Payment Annual Payment (automatic withdrawal) First payment will be pro-rated based

More information

TERRYTOWN COUNTRY CLUB

TERRYTOWN COUNTRY CLUB P.O. BOX 1285 1785 CAROL SUE AVE GRETNA, LA 70054 TERRYTOWN, LA 70056 terrytowncountryclub@gmail.com 504-392-7191 2018 RENEWAL LETTER & DUES NOTIFICATION Dear TCC Member(s): It is that time of the year

More information

Seasonal Court Information

Seasonal Court Information Summer 2018 Season Court Renewals Dates: May 14 th - Aug 31 st Season Courts are for Members Only 2017 Summer Court holders have until April 16 th in order to get priority renewal on last year s court

More information

Aviator GYMNASTICS Summer Day Camp Registration Form 2017 Price sheet Child s Name

Aviator GYMNASTICS Summer Day Camp Registration Form 2017 Price sheet Child s Name Aviator GYMNASTICS Summer Day Camp Registration Form 2017 Price sheet Child s Name Full Day Gymnastics Ages 5-16 9am-4pm Half Day / 8 Weeks 4 Weeks $ 1,500 3 Weeks $ 1,200 2 Weeks $ 850 1 Week $ 450 8

More information

Birthday Party Information

Birthday Party Information Birthday Party Information Parties are offered every Saturday and Sunday! Saturdays: 2:00 4:00 p.m. Sundays: 10:00 a.m. 12:00 p.m. OR 2:00 4:00 p.m. Four Different Themes to Choose From: 1. Extreme Sports

More information

NMCA 2019 ANNUAL CONVENTION April 12 & 13, 2019

NMCA 2019 ANNUAL CONVENTION April 12 & 13, 2019 NMCA 2019 ANNUAL CONVENTION April 12 & 13, 2019 EVERYTHING YOU NEED TO REGISTER AS AN EXHIBITOR FOR THE NMCA 2019 CONVENTION IS ENCLOSED!! PLEASE JOIN US!! Enclosed with this letter are a Registration

More information

MEMBERSHIP APPLICATION FORM

MEMBERSHIP APPLICATION FORM Name of Applicant: Name of Proposer: Name of Sponsor: MEMBERSHIP APPLICATION FORM Date: I/we hereby apply for the membership classification in the Race Brook Country Club, Inc., and agree that if my/our

More information

Winnetka Park District 2017 Season Boat Storage Application

Winnetka Park District 2017 Season Boat Storage Application Winnetka Park District 2017 Season Boat Storage Application WINNETKA PARK DISTRICT 540 Hibbard Rd., Winnetka, IL 60093 PHONE: (847) 501-2040 FA: (847) 501-5779 LLOYD SUMMER BOAT STORAGE RATES RESIDENT

More information

YMCA of the Coastal Bend Summer Camp 2018 Enrollment Form

YMCA of the Coastal Bend Summer Camp 2018 Enrollment Form PARTICIPANT INFORMATION: YMCA of the Coastal Bend Summer Camp 2018 Enrollment Form Child (1) Name: Sex: [M] [F] (circle one) of birth: / / Camp Type/Location: YMCA Day Camp (Pre-K - 5 th ) Downtown YMCA

More information

DANVILLE FAMILY YMCA MEMBERSHIP CONTRACT

DANVILLE FAMILY YMCA MEMBERSHIP CONTRACT DANVILLE FAMILY YMCA MEMBERSHIP CONTRACT 1 Name (First, Last): Date of Birth: Gender: Email: Address: City: State: Zip Code: Phone (Home): Cell: Work: Place of Employment/School: Emergency Contact: Phone:

More information

Account Opening Application CHILD BOND SAVINGS

Account Opening Application CHILD BOND SAVINGS Account Opening Application CHILD BOND SAVINGS 2 P a g e TERMS AND CONDITIONS FOR ACCOUNTS Updated May 2016 1 Application These Terms & Conditions apply to all Accounts, except where explicitly defined

More information

SAVANNAH COUNTRY CLUB MEMBERSHIP AGREEMENT

SAVANNAH COUNTRY CLUB MEMBERSHIP AGREEMENT SAVANNAH COUNTRY CLUB MEMBERSHIP AGREEMENT 501 WILMINGTON ISLAND ROAD SAVANNAH, GEORGIA 31410 912-897-1612 Savannah Country Club Levels Golf (30yrs- 71yrs) Monthly dues are $325.00. Full Golf includes

More information

Thank you for your interest in one of the Mid-DEL Property Management Properties. We are here to help you! Please feel free to reach out to us

Thank you for your interest in one of the Mid-DEL Property Management Properties. We are here to help you! Please feel free to reach out to us Thank you for your interest in one of the Mid-DEL Property Management Properties Please remember that we will need to have the following provided with each application for anyone over the age of 18 who

More information

T H E H E A LT H CLU B M E M B E R S H I P

T H E H E A LT H CLU B M E M B E R S H I P T H E H E A LT H CLU B M E M B E R S H I P MEMBERSHIP TYPE ANNUAL RATE 1 year single membership 550 1 year couple membership 1000 1 year family membership 2 adults + 2 children 1250 Golden Years (60 years

More information

The Membership fee will include only the following (subject to actual opening of the respective facilities and continued operation):

The Membership fee will include only the following (subject to actual opening of the respective facilities and continued operation): MEMBERSHIP AGREEMENT AND POLICIES red apple membership Membership and Payment The annual red apple membership fee is $1120 per family and entitles members ( Member, Members ) and their children to use

More information

Definitions 1. Capitalized words used in the terms and conditions of the Program are defined as follows:

Definitions 1. Capitalized words used in the terms and conditions of the Program are defined as follows: Diners Club Club Rewards Terms And Conditions Definitions 1. Capitalized words used in the terms and conditions of the Program are defined as follows: Account means an account for any type of Card; Authorized

More information

Travel to Iceland Registration Form

Travel to Iceland Registration Form Travel to Iceland Registration Form June 24 June 29, 2019 Please complete all six pages of this registration form and agreement and retain a copy for your records. One form for each individual passenger

More information

Membership Rewards Terms and Conditions

Membership Rewards Terms and Conditions Membership Rewards Effective 17 July 2018 The American Express Platinum Card for the Membership Rewards Ascent Premium program for American Express Cards. Effective 17 July 2018, these Terms and Conditions

More information

A Journey through Pueblo History and Tradition. Registration Packet

A Journey through Pueblo History and Tradition. Registration Packet A Journey through Pueblo History and Tradition Registration Packet Monday Friday June 5 June 16, 2017 9am 4pm Thank you for your interest in our Traditional Teachings Camp! Here s some information to review

More information

Before and After School Care

Before and After School Care Before and After School Care BLAIR FAMILY YMCA 2016-2017 School Year Registration Forms To put Christian principles into practice through programs that build a health spirit, mind and body for all. -YMCA

More information

Agent Mailing Address City State Zip Code. Agent Address

Agent Mailing Address City State Zip Code. Agent  Address Application Medicare-Eligible Basic Plan Questions? Call 1-800-877-5187 Please type or PRINT in black ink All sections must be filled out completely Your premium and required documents should be included

More information

Plan Administrator Guide

Plan Administrator Guide Plan Administrator Guide TABLE OF CONTENTS 3 Secure Employer Website 4 Enrollment Center 5 Billing Management 6 Reports 7 Eligibility and enrollment 8 Special enrollment We provide tools to make it easy

More information

2019 MBA Spring Tour Saturdays and Sundays April 27 May 12, 2019

2019 MBA Spring Tour Saturdays and Sundays April 27 May 12, 2019 2019 MBA Spring Tour Saturdays and Sundays April 27 May 12, 2019 PARTICIPATION PACKET Be a part of Wisconsin s largest open house featuring new home construction, remodeling projects, condominiums, subdivisions

More information

Instructions for Fax or Applications for Service

Instructions for Fax or  Applications for Service 845 Galvez Street, Mandeville, LA 70448-4934 985.626.5132 www.h2osystemsinc.com Instructions for Fax or Email Applications for Service To complete your application for water and sewer services via fax

More information

CITY OF PALM COAST YOUTH PARKS & RECREATION DEPARTMENT ADULT REGISTRATION FORM SENIOR

CITY OF PALM COAST YOUTH PARKS & RECREATION DEPARTMENT ADULT REGISTRATION FORM SENIOR CITY OF PALM COAST YOUTH PARKS & RECREATION DEPARTMENT ADULT REGISTRATION FORM SENIOR Please print clearly. Completion of the registration process is required for each participant prior to program start

More information

Membership Application For

Membership Application For Membership Application For Silver Willow in this document means Silver Willow Pheasant Farm LTD. Don Day, Gwen Day and Josh Day NOTES FOR APPLICANTS Please read this form carefully especially the declaration

More information

Extended Day Care Program

Extended Day Care Program Dear Parents/Guardians: Extended Day Care Program 2017-2018 Thank you for your interest in our Extended Day Care Program. Orlando Science School would like to welcome you and your student(s) to our Program.

More information

Registration Packet. May 22 May 26, am 3pm

Registration Packet. May 22 May 26, am 3pm A Journey through Pueblo History and Tradition Registration Packet May 22 May 26, 2017 9am 3pm Thank you for your interest in our Traditional Teachings Camp! Here s some information to review as you register:

More information

WINCHESTER HOMEOWNERS ASSOCIATION, INC. Special Outside Pool and Tennis Membership Request

WINCHESTER HOMEOWNERS ASSOCIATION, INC. Special Outside Pool and Tennis Membership Request -2017- WINCHESTER HOMEOWNERS ASSOCIATION, INC. Special Outside Pool and Tennis Membership Request Please complete the attached application form and return with payment to: Winchester HOA, Inc. (NRM) C/O

More information

Evaluation and Team Registration Information

Evaluation and Team Registration Information Tryout Date: May 26, 2018 Evaluation and Team Registration Information Time: (3-5 years) 9:00 to 10:00 Time: (6-10 years) 10:00 to 12:00 Time: (11-13 years) 1:00 to 3:00 Time: (14-18 years) 3:00 to 5:00

More information

PLEASE RETAIN THIS PAGE FOR YOUR RECORDS

PLEASE RETAIN THIS PAGE FOR YOUR RECORDS RETURN TO WORK POLICY If you are receiving an early or normal retirement benefit: You must immediately notify the NEBF if you return to work in the electrical industry for forty (40) or more hours per

More information

Bramalea City Centre FashioniCITY Rewards Club Program Terms

Bramalea City Centre FashioniCITY Rewards Club Program Terms Bramalea City Centre FashioniCITY Rewards Club Program Terms This agreement provides the terms and conditions under which individuals may participate (as members ) in the Bramalea City Centre / FashioniCITY

More information

Trade Contractor s Applications

Trade Contractor s Applications Trade Contractor s Applications Master and Journeyman Applicants: must show proof of receiving a passing score of 75% + from one of the following testing agencies - Block, NIA-Block, Experior, Thomson-Prometric

More information

STAY ACTIVE STAY CONNECTED AT THE PISCATAQUIS REGIONAL YMCA

STAY ACTIVE STAY CONNECTED AT THE PISCATAQUIS REGIONAL YMCA STAY ACTIVE STAY CONNECTED AT THE PISCATAQUIS REGIONAL YMCA WE RE MORE THAN A GYM, we are a community committed to strengthening bodies, minds, and spirits. Since 1988, the Piscataquis Regional YMCA has

More information

Top Shot Membership INDIVIDUAL & FAMILY MEMBERSHIP MEMBERSHIP APPLICATION AND AGREEMENT INSTRUCTIONS

Top Shot Membership INDIVIDUAL & FAMILY MEMBERSHIP MEMBERSHIP APPLICATION AND AGREEMENT INSTRUCTIONS Top Shot Membership MEMBERSHIP APPLICATION AND AGREEMENT INSTRUCTIONS The Membership Application package consists of the following pages: Membership Application and Agreement (1 page) ( Application ) Terms

More information

All Star PREP Team Registration Form

All Star PREP Team Registration Form 2018-2019 All Star PREP Team Registration Form Please fill out and return the following information: Returning PREP Team Athlete: *Prep Registration Form by May 15th New PREP Team Athlete: *Prep Registration

More information

MORE REWARDS PROGRAM TERMS AND CONDITIONS

MORE REWARDS PROGRAM TERMS AND CONDITIONS MORE REWARDS PROGRAM TERMS AND CONDITIONS 1. The More Rewards customer loyalty program ( More Rewards ) is administered by the Overwaitea Food Group Limited Partnership ( OFG ). The More Rewards name and

More information

1. PERSONALIZED PRIMARY CARE Benefits and Services. The Program provides the following amenities ( Amenities ) to persons who sign up as Members:

1. PERSONALIZED PRIMARY CARE Benefits and Services. The Program provides the following amenities ( Amenities ) to persons who sign up as Members: MEMBERSHIP AGREEMENT This Membership Agreement (the Agreement ) specifies the terms and conditions under which you, the undersigned member ( Member ), will be enrolled with PERSONALIZED PRIMARY CARE program

More information

Hubert's Stand TERMS

Hubert's Stand TERMS Hubert's Stand TERMS Last Updated: May 16, 2018 PLEASE READ CAREFULLY. By participating, you agree to the following terms and conditions governing the Hubert's Stand Loyalty Program (the "Terms"). A. Overview

More information

To enroll your child in our program, please provide the following 4 items:

To enroll your child in our program, please provide the following 4 items: 4211 Waialae Ave #30, Honolulu, HI 96816 Phone: (808) 735-8811 Email: info@bbprekhawaii.com Aloha! Welcome to Bright Beginnings! To enroll your child in our program, please provide the following 4 items:

More information

Convenience Services Application

Convenience Services Application Convenience Services Application I am applying for the following service(s). (Note: A separate application is needed for each accountholder applying for services.) Cash & Check Debit Card (w/ ATM access)

More information

2019 Indoor Baseball Clinic Boys Ages 7-10

2019 Indoor Baseball Clinic Boys Ages 7-10 Department of Parks & Recreation - Recreation Division 101 Field Point Road, Greenwich, CT 06836-2540 Phone: (203) 618-7649 Email: Recreation@greenwichct.org 2019 Indoor Baseball Clinic Boys Ages 7-10

More information

MERCH VENDOR/EXHIBITOR BOOTH APPLICATION

MERCH VENDOR/EXHIBITOR BOOTH APPLICATION MERCH VENDOR/EXHIBITOR BOOTH APPLICATION JUNE 21-22, 2019 SHELDON, IA Please send completed registration and payment to RISE Ministries by April 25, 2019 : RISE Ministries 517 Park Street Sheldon, IA 51201

More information

Golden Gate School of Feng Shui Application and Registration

Golden Gate School of Feng Shui Application and Registration Golden Gate School of Feng Shui Application and Registration 2010-2011! Today s Date Legal Name AKA Name(s) Address City State Zip Home Phone Mobile Work Phone Email Date of Birth Place of Birth Country

More information

Youth & Government REGISTRATION FORM

Youth & Government REGISTRATION FORM Youth & Government REGISTRATION FORM CHOOSE 1 of 2 PAYMENT OPTIONS 1. Enclosed is my check* or credit information to pay in full: Facility Members - $1,250 Program Members** - $1,450 * If using a checking

More information

maxima APPLICATION FORM

maxima APPLICATION FORM maxima APPLICATION FORM SECTION 1 CHOICE OF OPTION Choose ONE product option by placing x in the appropriate box Comprehensive Options Saver Options Hospital Plans MAXIMA PLUS MAXIMA EXEC MAXIMA STANDARD

More information

Travel to Scotland Registration Form

Travel to Scotland Registration Form Travel to Scotland Registration Form September 21 September 28, 2019 Please download and complete all six pages of this registration form and agreement and retain a copy for your records. One form for

More information

M EMBERSHIP A PPLICATION

M EMBERSHIP A PPLICATION M EMBERSHIP A PPLICATION P ERSONAL I NFORMATION Name (Please Print):! Mr.! Mrs.! Ms.! Dr.! Other Home Address: Home Phone: Primary Email: Out-of-Town Address: Cell Phone: Date of Birth: Applicable Dates:

More information

Pocock Rowing Center

Pocock Rowing Center Pocock Rowing Center Office Use QB LGL XL S Code Membership Forms New Member Existing Member Former Member First Name: Last Name: Address: City: St: Zip: Email Address: Cell Phone ( ) Alt Phone: ( ) Gender:

More information

WELCOME TO STANLY COUNTY GYMNASTICS!

WELCOME TO STANLY COUNTY GYMNASTICS! WELCOME TO STANLY COUNTY GYMNASTICS! 1960 Post Rd. Albemarle, NC 28001 Phone: 704-983-2414 Email: stanlycountygymnastics@gmail.com Website: www.stanlycountygymnastics.wildapricot.org Stanly County Gymnastics,

More information

Disney s Aladdin Digital Lottery. Terms and Conditions

Disney s Aladdin Digital Lottery. Terms and Conditions Disney s Aladdin Digital Lottery Terms and Conditions NO PURCHASE OR PAYMENT NECESSARY TO ENTER OR PARTICIPATE IN A LOTTERY. YOU MAY ENTER A LOTTERY FOR A CHANCE TO PURCHASE UP TO THE NUMBER OF TICKETS

More information

Subscription for a Share and Membership Application for the. The Winston Golf Club Ltd. (the Club ) Applicant Information

Subscription for a Share and Membership Application for the. The Winston Golf Club Ltd. (the Club ) Applicant Information Subscription for a Share and Membership Application for the The Winston Golf Club Ltd. (the Club ) Applicant Information Title (Mr., Mrs. Ms. Dr.) Date of Birth Last Name, First Name, and Middle Initial

More information

New Member Application

New Member Application New Member Application Thank you for your application for membership in the (ESC) New member applications will be accepted beginning April 1, 2016 and continue until the Board of Directors determines that

More information

Pool/Tennis Membership Family Pool/Tennis Only ($600) Single Pool/Tennis Only ($300) Range Plan, Bag Storage, and Trail Fee

Pool/Tennis Membership Family Pool/Tennis Only ($600) Single Pool/Tennis Only ($300) Range Plan, Bag Storage, and Trail Fee Full Access Membership - (Includes Golf, Pool and Tennis) Family ($2100/yr or $183.34/mo for 12 mo.) Single ($1800/yr or $158.34/mo for 12 mo.) Active Duty/Retired Military Family ($1900/yr or $166.67/mo

More information

Membership Application Form

Membership Application Form Membership Application Form Silver Willow in this document means Silver Willow Pheasant Farm LTD. Don Day, Gwen Day and Josh Day NOTES FOR APPLICANTS Please read this form carefully especially the declaration

More information

50Plus Expo. (805)

50Plus Expo. (805) The Pleasant Valley Recreation and Park District Senior Center invites you to participate in the 12th annual 50 Plus Expo on May 1, 2018 from 9:30am to 1pm, at the Community Center, 1605 E. Burnley St.,

More information

Racing Rewards Program Terms & Conditions

Racing Rewards Program Terms & Conditions Important information for Members about the Racing Rewards Program Effective Date: 1 July 2017 Newcastle Jockey Club is pleased to introduce the Racing Rewards Program for the 2017/18 season which will

More information