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: Spouse s Name: Email Address: Birthdate: Billing Address: Telephone: Primary ( ) Telephone: Secondary ( ) Fax Number: ( ) Unmarried children under the age of 23: Name Birthdate Charge Privileges (Circle one)
BUSINESS Member s Company Name: Title: Business Address: Telephone: ( ) Years in Present Employment: (Retired) Fax Number: ( ) Website Spouse s Company Name: Title: Spouse s Business Address: Telephone: ( ) Years in Present Employment: (Retired) Fax Number: ( ) Website 1. Name of Club/Organization OTHER CLUBS Type City and State Year Accepted Present Member (/) 2. Name of Club/Organization Type City and State Year Accepted Present Member (/)
II. I hereby apply for the following category of Membership in The Club at Bella Collina: (please check one) Initiation Fee Monthly Dues o Family Golf & Sports Waived $750 o Individual Golf & Sports Waived $500 o Family Golf Waived $600 Individual Golf Waived $400 Family Sports Waived $400 Individual Sports Waived $250 Family Social Waived $150 I understand that membership is contingent upon approval by the Club, which approval shall be at its discretion. Upon signing this Agreement, I authorize the disclosure and release of information to the Club for investigating my qualifications for Membership, including my credit history and background check and agree to hold the Club harmless from any and all such acts. I understand that a $200 application fee is applied to this application which includes the background check. III. PAYMENT OF DUES, FEES, AND CHARGES I hereby agree to pay to the Club the Membership dues, fees and charges, including any applicable sales tax, or other taxes, for the category of Membership privileges selected above. The current amount of dues, for each category of Membership privileges is described on a separate Schedule of Dues, Fees and Charges, and is subject to change, as set forth in the Club Membership Plan. In the event that any amount owed to the Club is not paid on a timely basis, I understand that I may be charged a late payment in accordance with the Rules and Regulation. Members who are not in good standing will be sent collection letters and then access privileges suspended. Per the agreement, I am required to maintain a membership for a minimum of 12 months and if my membership is suspended OR terminated during the Minimum Activation Period, I agree dues and fees shall continue to accrue thru the end of the Membership Activation Period. At the end of the 12 months, the membership will automatically be renewed unless otherwise requested by the member. I hereby authorize that all dues, fees and charges be billed to my credit card listed below and hereby authorize such billing. I certify that the below listed card is issued to me and agree that all disputes on my credit card account relating to the Club will be promptly brought to the Club s attention. I understand that I am obligated to keep a valid approved credit card on file with the Club at all times and that I am responsible for any amounts that are not paid by the credit card company. Credit Card Type Expiration Date Credit Card Number Zip Code Cardholder Signature Security Code IV. NONREFUNDABLE INITIATION FEE
Each person who desires to acquire an Invitational Membership will be required to pay a nonrefundable initiation fee in an amount determined by the Club in its sole discretion. I acknowledge that upon recall of my Invitational membership, I shall not be entitled to any refund or repayment of the initiation fee. From time to time, the Club may waive the initiation fee or may allow for a refund of some portion of the initiation fee actually paid by a member. twithstanding any other provisions of this Membership Agreement to the contrary, under no circumstances will a member be entitled to a refund or repayment of any initiation fee. The exception to this rule would be if such initiation fee was actually paid by the member and only after the Club has deducted from such refund amount any monies due and owing the Club at the time of such refund as more fully set forth in the Club Membership Plan, and the Rules and Regulations (the Membership Document ). I understand that provisions set forth in the Membership Documents pertaining to membership deposits are not applicable to Invitational Memberships. V. GENERAL INVITATIONAL MEMBERSHIP TERMS Initial Membership Period. I understand and acknowledge that an Invitational Membership is recallable by the club, in its sole discretion, at any time. Application Fee. I understand that there is a non-refundable $200 application fee to apply for membership at The Club at Bella Collina. A background check will be conducted. Minimum Activation Period. I agree to maintain an active club membership, in good standing, for a minimum period of twelve months from the date on which my membership is activated. Should my membership be suspended or terminated during the Minimum Activation Period, I understand and agree that membership dues and fees shall continue to accrue through the end of the Membership Activation Period and such dues and fees shall be paid to the club. Membership in Good Standing. I agree to comply with the terms and provision of the Club including the requirement that I maintain my club membership in good standing. Failure to maintain my membership in good standing may result in the suspension and/or termination of my membership privileges. The Club retains the right to utilize various collection efforts to collect delinquent dues and fees outstanding. Family and Guest Privileges. I understand and acknowledge that Extended Family and House Guest privileges, as they are set forth in the Membership Documents, are not available to Invitational Members. I further understand that all Day Guests must be accompanied by their hosting Invitational Member at all times. n-transferable Memberships. I understand and acknowledge that with the exception of provisions related to legal separation or divorce of married members, documents are inapplicable to Invitational Memberships. Invitational Memberships may not be transferred or assigned. Membership Cards and Epass. I understand that a membership card will be issued to each person included in the membership. Replacement cards will incur a $10.00 fee. I understand that 2 Epasses will be issued per family for convenient access to Bella Collina. Any additional Epasses will be $25.00 each.
VI. ACKNOWLEDGEMENT OF MEMBERSHIP RIGHTS The Club reserves the right, in its sole discretion, to terminate or modify the terms and conditions of the membership, to reserve memberships, to sell, lease, or otherwise dispose of the Club facilities in any manner whatsoever and to any person whomsoever, to add, issue, modify, or terminate any type of category or class of membership, to discontinue operation of any or all of the Club facilities, to convert the Club into a member-owned club, and to make any other changes in the terms and conditions of the membership or the Club facilities available for use by its members. In the event of termination of the membership, termination of any category of membership, or the discontinuance of operation of all or substantially all of the Club facilities, the affected members will not be entitled to a refund of the Initiation Fee paid by the member. In the event that the Club facilities are sold, the buyer shall take title subject to the terms and provisions of the then existing Membership Plan. I hereby acknowledge that the use of the Club facilities and any privilege or service incident to membership is undertaken with knowledge of risk of possible injury. I hereby accept any and all risk of any event or activity incident to the membership in the Club. I agree to release, indemnify, and hold harmless the Company, their affiliates, successors and assigns and their respective directors, officers, partners, members, shareholders, employees, representatives and agents and the member of the Advisory Board of Governors of the Club and any Club and any Club committee in accordance with the provisions of the Rules and Regulations of the Club from and against any and all loss, cost, claim, injury, damage, or liability associated use of the Club facilities. If the prospective member is married, the signatures of both spouses are required. Dated:, 20 Applicant s Signature Printed Name Dated:, 20 Spouse s Signature Printed Name Referred By: This Membership Agreement shall not be binding by the Club until the acceptance below is signed. ACCEPTED BY: THE CLUB AT BELLA COLLINA, LLC By: Authorized Representative Printed Name: Dated:, 20 The Club at Bella Collina 16355 Vetta Drive, Montverde, Florida 34756 (407) 469-4000
Member Status: Club Approval: Last Name: First Name: Today s Date: EPASS INFORMATION SHEET (please print) Member Number: Resident Property Owner Invitational Employee Name: First Name: Spouse Name: (Members Only) Address: D.L. #: Phone #: VEHICLE INFORMATION Make: Model: Tag# State of Issuance: Year: Color: Tag Expiration: Issued Driver Signature: Issuing Security Officer Signature: Charge ($30) Club Signature: ***IMPORTANT*** In order to prevent a security breach and/or a possible misuse of your epass please notify security when you sell, end lease, or trade your vehicle in order for us to update our records. Issuance of the epass does not imply nor grant absolute access to The Club at Bella Collina. Security reserves the right to stop any and all vehicles entering or exiting the property. You may still be asked to produce photo identification. Upon termination of employment, residency or membership the epass must be returned to security. The epass is the property of The Club at Bella Collina. You also agree to follow and obey all traffic regulations, including going around the roundabouts, approaching the gate at 10 MPH and follow the SPEED LIMIT of 25 MPH throughout property. Additional epasses can be purchased for $30.00 each. BY SIGNING THIS DOCUMENT, YOU HAVE REVIEWED AND AGREE TO THE POLICIES LISTED ABOVE. THANK YOU OFFICIAL USE ONLY Epass #: Previous Epass #: Issue date: Deactivation Date: Reason for Deactivation: Entered into computer system by: Vehicle Being Replaced: Name: Date:
AUTHORIZATION AND CONSENT FOR THE RELEASE OF INFORMATION TO THE CLUB AT BELLA COLLINA and THE BELLA COLLINA POA One form required for each adult (over 18 years of age) I hereby authorize The Club at Bella Collina and the Bella Collina Property Owners Association and/or any of its authorized agents to gather background information. This information includes criminal history, credit records and social security number verification related to my application for membership/ownership. I also authorize this information to be reverified at any time during my membership/ownership. I understand that all information provided on this release is for identification purposes only and is necessary in order to conduct a background check. I understand that all information is gathered in accordance with the provisions of the Fair Credit Reporting Act (FCRA). I understand that the inquiries and verifications conducted are for the purposes of my membership/ownership only and are not an invasion of my privacy. In compliance with the FCRA, I understand a copy of this report will be provided to me upon my written request. I,, hereby declare and affirm that the following information is true Signature Date and correct to the best of my knowledge. In addition, I understand that submission of false or inaccurate information on this and/or any other membership forms may result in denial or cancellation of membership. (PLEASE PRINT) Last Name First Name MI Social Security Number Driver s License Number State of Issue Date of Birth (month, day, year) Former Names (i.e. Maiden, Previous Married Names, Legal Name Changes) Name: Dates from/to: Current Address Dates from/to: City, State, Zip County Previous (Past 7 years) Dates from/to: City, State, Zip County 1. 2. 3. 4. 5. THE SECTIONS BELOW ARE FOR INTERNAL USE ONLY The following services will be conducted: Criminal History, Social Security Verification, Credit Check Company Name: The Club at Bella Collina and the Bella Collina POA Submitted by Email: Phone Number: Date: