M EMBERSHIP A PPLICATION

Transcription

1 M EMBERSHIP A PPLICATION P ERSONAL I NFORMATION Name (Please Print):! Mr.! Mrs.! Ms.! Dr.! Other Home Address: Home Phone: Primary Out-of-Town Address: Cell Phone: Date of Birth: Applicable Dates: Company: Title: Company Address: Company Phone: Years in Present Employment: Marital Status: " Single " Married Preferred Correspondence Address: " Home " Business Name (Please Print): S POUSE/MEMBER D ESIGNEE I NFORMATION Primary Date of Birth: Company: Company Address: Company Phone: Years in Present Employment: CLUB USE ONLY: member # category: Revised 4/15/2012 Stoneleigh G&CC Membership Application 1

2 C HILDREN (UNDER A GE 21) Please Indicate Interest in: Name DOB Gender Swim Team Swim Lessons Golf Golf Lessons Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N 3. Y/N Y/N Y/N Y/N 4. Y/N Y/N Y/N Y/N 5. Y/N Y/N Y/N Y/N B ANK R EFERENCES Institution Contact Account # Phone P ERSONAL R EFERENCES Stoneleigh Name Relationship Years Known Phone Member 3.!!! O THER C LUB A FFILIATIONS Club Contact Years Phone 3. Revised 4/15/2012 Stoneleigh G&CC Membership Application 2

3 M EMBERSHIP A PPLICATION T ERMS OF MEMBERSHIP I am applying to Stoneleigh Golf, LC (the Owner ) for a membership in Stoneleigh Golf & Country Club (the Club ) in the membership class and category checked below. Initiation Fee: $. C LASS OF M EMBERSHIP! Golf Membership! Social Membership C ATEGORY OF M EMBERSHIP! Full! Associate! Class B! Social! Corporate! Non-Resident! Honorary P AYMENT OF I NITIATION F EE I agree to pay my Initiation Fee by the payment method checked below:! Payment of the Initiation Fee in Full: I agree to pay the Initiation Fee in full with the execution of this Membership Application; or! Payment of the Initiation Fee in Installments: I agree to pay the Initiation Fee as follows: (a) (b) An initial payment of $ is paid with this Membership Application, as a partial payment of the total Initiation Fee; and The unpaid balance of $ shall be due and payable with interest at the rate of % per annum, at Prestwick Court, Round Hill, Virginia 20141, or at such other place as shall be designated by the Owner in writing, on the dates and in the manner following: Payments will be due:! monthly! quarterly! annually Payment amounts: First payment due: Last payment due: $, plus all accrued interest Revised 4/15/2012 Stoneleigh G&CC Membership Application 3

4 The unpaid balance of the Initiation Fee may be pre-paid at anytime together with all accrued interest thereon. I acknowledge and agree that if I fail to pay any Initiation Fee installment within thirty (30) days of the due date up to the date of my resignation, then (i) my membership shall terminate at the Owner s option; (ii) the Owner shall retain all installments of my Initiation Fee previously paid (including interest payments) and I will not be entitled to the repayment on any portion thereof on the Repayment Date (as defined below); and (iii) I shall remain responsible for any bills and charges that I have incurred and which remain unpaid and owing as of the date of such forfeiture and termination. Upon all of the foregoing, I will be released from all liability for any further payments of my Initiation Fee. P AYMENT OF D UES, F EES AND C HARGES I acknowledge that payment of my account (i.e., dues, fees and charges) is due on the first day of every month. I agree to pay the account when due and I authorize the Owner to charge my credit card for the payment of my account. If the Owner is unable to timely collect my account paid by charging my credit card, I agree that a late charge and/or interest 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. I acknowledge that the Owner may take whatever action it deems necessary to effect collection, including without limitation, suspension or termination of my membership or legal action, and I shall be liable for all costs and for any expenses of such legal action and reasonable attorneys fees, including any fees required in connection with appellate proceedings. Payments on delinquent accounts apply first to reduce late charges and accrued dues, then to food and beverage charges, then to any other charges. I hereby acknowledge and agree that all dues, fees and charges may be charged to my credit card. I certify that the below listed card is issued to me and all disputes on my account will be directed to the Owner. I agree to maintain a major credit card account in my name on file with the Club at all times. Credit Card #: Exp. Date: CVC: Cardholder Name: Billing Address:! Home! Work! Other (give address below) Other Address: R E CEIPT O F M EMBERSHIP P LAN If accepted into membership, I agree to conform to and be bound by this Membership Application, the Bylaws, the Rules and Regulations and written membership policies of the Club, as each may be amended from time to time (collectively, the Membership Documents ). I further understand that agreeing to be bound by the Membership Documents is part of my agreement for membership privileges with the Club. I hereby acknowledge receipt of, and that I have read, a copy of Bylaws and the Rules and Regulations of the Club. I hereby acknowledge that this Membership Application will not be acted upon unless fully completed and signed. A PPROVAL FOR M EMBERSHIP IN THE C LUB I understand that this Membership Application will be subject to approval by the Owner, in its sole and absolute discretion, and my payment of the required Initiation Fee, dues, fees and charges established by the Owner from time to time. I hereby acknowledge that my membership constitutes a revocable license to use the Club facilities made available for use from time to time and does not confer upon me any ownership interest, or any vested or prescriptive right or easement, in or to the facilities of the Club. Revised 4/15/2012 Stoneleigh G&CC Membership Application 4

5 V ERIFICATION Upon signing this Membership Application, I hereby authorize the disclosure and release of information to the Owner for investigating my qualifications for membership and authorize those persons or entities named by me herein to furnish information to the Owner, including providing a credit report to the Owner. H OLD H ARMLESS I hereby acknowledge that the use of the Club facilities and any privilege or service incident to membership is undertaken with knowledge that it may involve a risk of physical injury. I expressly assume any and all risk of injury to myself, my guests and my family sustained while using the Club facilities or involved in any event or activity incident to membership in the Club. In consideration of receiving permission to use the Club facilities, I agree to pay the costs incurred to defend, indemnify, release and hold harmless, the Owner, the Club, their affiliated companies, their respective agents, management companies, officers, directors, owners, contractors and employees (collectively, the Released Parties ) from any and all claims I might state as a result of physical injury, including death, or property damage sustained in connection with the Club, including, without limitations those claims based on negligence or breach of contract. I promise not to sue the Released Parties and further agree that if anyone is physically injured, property is damaged or any other loss suffered while I am engaged in activities or events at the Club facilities, I will have no right to make a claim or file a lawsuit against the Released Parties. I agree to pay the costs incurred to defend and indemnify the Released Parties for any and all claims, including subrogation and/or derivative claims brought by any third party or insurer, which I may cause. This Membership Application shall be governed by and construed in accordance with the laws of the State of Virginia without regard to principles of conflicts of laws. M EMBERSHIP R EFERRALS The Club's preferred source of growth is referrals from Members. Please indicate friends or associates you suggest be invited to consider membership Name Phone Relationship Revised 4/15/2012 Stoneleigh G&CC Membership Application 5

6 If the applicant is married, the signatures of both spouses are required. Applicant Signature: Spouse Signature: Date: Date: This Membership Application shall not be binding upon the Club until the acceptance below is signed. Approved and Accepted for Stoneleigh Golf, LC: Signature: By (Printed Name): Title: Date: Upon my acceptance to the Club please bill my account for the following incidental expenses. # of locker requests - Men s: Women s: Payment: # of bag storage requests: Payment: # of pull cart storage requests: Payment: RETURN COMPLETED APPLICATION TO: STONELEIGH G & CC, ATTN: MEMBERSHIP DIRECTOR PRESTWICK COURT, ROUND HILL, VIRGINIA TEL. (540) FAX (540) MEMBERSHIP@STONELEIGHGOLF.COM CLUB USE ONLY: Club Initials: Membership Category: Membership # Rider Attached (check if applicable):! Corporate! Associate! Other Dues/month: Initial payment amount: Date: Subsequent dues payment amounts: Initiation Fee total: Redemption %: Initiation Fee due now: Payment: Initiation Fee financed: Interest %: Date entire Initiation Fee received: Effective date of resignation of membership: Other comments: Club Initials: Club Initials: Revised 4/15/2012 Stoneleigh G&CC Membership Application 6