Membership Application Type of Membership Member Name Home Address Phone_( ) Date of Birth / / Fax _( ) Social Security No. - - Business Address: Company Name Address Phone_( ) Position Fax _( ) E-Mail Address Organizations in which you are a member Family Information (If Applicable, includes spouse and children through age 25): Name Relationship Date of Birth if Golfer Spouse / / Date and Place of Marriage Child / / Child / / Child / / Check box if you desire a locker for: Yourself Spouse Do you wish to maintain a handicap for: Yourself Spouse Child Do you wish your statements sent to: Home Business Do you wish your newsletters sent to: Home Business
The following items must be submitted with signed application: Check for $l00 Non-Refundable Application Fee Waiver Authorization - Credit History Waiver Authorization - Criminal History Personal Photograph Sponsorship letters from two current Kirkbrae members. (A personal interview may be arranged if you are not familiar with any members.) I under st and t hat al l i nf or mat i on cont ai ned i n t hi s appl i cat i on i s mat er i al i nf or mat i on. Any mi sst at ement, f al se, mi sl eadi ng or ot her wi se i naccur at e i nf or mat i on pr ovi ded t o t he Cl ub by me shal l be a basi s f or ei t her my nonaccept ance as a member, or my r emoval as a member i f such mi sst at ement, f al se, mi sl eadi ng or ot her wi se i naccur at e i nf or mat i on i s r eveal ed subsequent t o my admi ssi on t o member shi p. Have you ever used a name ot her t han t he name used i n t hi s appl i cat i on? Yes No I f yes, gi ve det ai l s Have you been convi ct ed of any cr i mi nal of f ense ot her t han t r af f i c vi ol at i ons? Yes No If yes, gi ve dat e and det ai l of each convi ct i on. The under si gned her eby makes appl i cat i on t o become a Member of Ki r kbr ae Count r y Cl ub; agr eei ng t o abi de by i t s const i t ut i on, by- l aws, r ul es and r egul at i ons t her eof. I under st and t hat al l dues and i ni t i at i on f ees pai d ar e non- r ef undabl e. I under st and t hat t he char ges on my account ar e due and payabl e upon r ecei pt of my mont hl y st at ement. I n t he event payment i s not made and t he account i s r ef er r ed t o a col l ect i on agency or an at t or ney, I agr ee t o pay al l r easonabl e col l ect i on, at t or ney s and cour t f ees and ot her expenses i nvol ved i n t he col l ect i on of t he char ges under t hi s cont r act. Signature Date We, t he under si gned, ar e per sonal l y acquai nt ed wi t h t he above appl i cant and r ecommend hi m f or member shi p. Print Name of Proposer Signature of Proposer Date Print Name of Seconder Signature of Seconder Date For Office Use Check Credit Criminal Photo Sponsor I Sponsor II BOG
WAIVER AUTHORIZATION - CRIMINAL HISTORY This Waiver Authorization expressly authorizes any State, Federal or Local Police Department, or law enforcement agency, to furnish Kirkbrae Country Club any and all criminal information it may have concerning me. Full Name Date of Birth / / Social Security Number - - Present Address How Long at Present Address Prior Address How Long at Prior Address Witness Signature Print Witness Name.
CREDIT APPLICATION Type or Print Clearly KIRKBRAE Country Club, 197 Old River Road, Lincoln, RI 02865 Requested Purpose: New Member Application Applicant: SS #: - - First Middle Last Home Phone: - - Date of Birth: - - Month Day Year Current Address: How Long: Previous Address 1: How Long: Current Employer: Phone: - - Employer Address: How Long: Position: Bank Name: Please Circle: Checking: YES / NO Savings: YES / NO The undersigned applicant(s) apply to the KIRKBRAE Country Club named above for an obligation defined as a legitimate permissible purpose as indicated above and allowed by the Fair Credit Reporting Act,15 U.S.C. 1681. By signing below the applicant(s) certifies that all the above information is true and correct in every respect. This application is not for employment or any restricted purpose. Applicant(s) hereby authorizes the KIRKBRAE Country Club, and/or its agent Strategic Information Resources, Inc., to verify any and all of the above information and to obtain a consumer credit report. Applicant(s) understands and agrees that the decision to grant or deny the request contained herein is at the sole discretion of the KIRKBRAE Country Club. APPLICANT S SIGNATURE: Date: KIRKBRAE Country Club by: Date: Membership Secretary
Family Golf Memberships Family memberships include spouse and single children living at home through age 25. All family members have access to the following areas of the Club; golf, locker rooms, pool, tennis, health club, and member's private dining room. (There are limitations for children in certain areas.) AA Golf Family Golf Junior Exec. Family (Available to members 35 & under) Voting Rights Yes (1 vote) Yes No Payable on Acceptance: Initiation Fee $ 3,500 $ 3,500 $ 3,500 Receive $500 dues credit beginning year #2, and $1,250 dues credit beginning year # 3 (Or pay monthly $100 per month for 35 months) Dues (Includes Greens, Bag/Range, Handicap, Tournament, Full Locker for Member & spouse or child 18+) $ 10,050 Dues (Includes Greens, Bag/Range, Handicap, Tournament, Full Locker for Member) $ 7,550 $ 6,591 Usage fees for additional family members include: Ladies Locker Fee included $ 175 $ 175 Bag/Range Fee included $ 150 $ 150 Handicap Fee included $ 25 $ 25 * House Fees $ 55 $ 55 $ 55 Minimum Spending (includes food and alcohol) $ 125 $ 125 $ 125 Building Maintenance Plan (for first 60 months of membership) $ 25 $ 25 $ 25 Golf Course Improvement Plan (for first 60 months of membership) $ 25 $ 25 $ 25 Cart Rental $ 22 $ 22 $ 22 Greens Guest Fees - Weekdays $ 55 $ 55 $ 55 Greens Guest Fees - Friday, Saturday & Holidays $ 75 $ 75 $ 75 Pool Guest Fees $ 8 $ 8 $ 8 Miscellaneous Fees: Special Assessments (At the discretion of the Board, limit 1 per year) $ 100 $ 100 $ 100
Single Golf Memberships Single memberships for the member only with access to the following areas of the Club; golf, locker rooms, pool, tennis, health club, and member's private dining room. Single Golf Junior Exec. I Single (Available to members age 35 & under) Junior Exec. II Single (Available to members age 36 to 40) Limited Single (Golf privileges restricted to certain times) Voting Rights Yes No No Yes Payable on Acceptance: Initiation Fee $ 3,500 waived waived $ - Receive $500 dues credit beginning year #2, and $1,250 dues credit beginning year # 3 (Or pay monthly $100 per month for 35 months) Dues (Includes Greens, Bag/Range, Handicap, Tournament, and Full Locker for Member) $ 6,280 $ 3,860 $ 4,760 $ 5,130 Social Family Add-on (Allows spouse and single children living at home through age 25 access to the following areas of the Club; pool, tennis,health club, and member's private dining room. (There are limitations for children in certain areas.) $ 375 $ 375 $ 375 $ 375 * House Fees $ 55 $ - $ - $ 55 Minimum Spending (includes food and alcohol) $ 125 $ 75 $ 125 $ 125 Capital Improvement Fund (for first 36 months of membership) $ - $ - $ - $ 75 Building Maintenance Plan (for first 60 months of membership) $ 25 $ 25 $ 25 $ 25 Golf Course Improvement Plan (for first 60 months of membership) $ 25 $ 25 $ 25 $ 25 * Administrative fee on all food and beverage purchases 20% 20% Cart Rental $ 22 $ 22 $ 22 $ 22 Greens Guest Fees - Weekdays $ 55 $ 55 $ 55 $ 55 Greens Guest Fees - Friday, Saturday & Holidays $ 75 $ 75 $ 75 $ 75 Pool Guest Fees $ 8 $ 8 $ 8 $ 8 Miscellaneous Fees: Special Assessments (At the discretion of the Board, limit 1 per year) $ 100 $ 100 $ 100 $ 100
Junior Golf Memberships Member (Available to current members Non Member (Available to non members) Voting Rights No No Payable on Acceptance: Dues (Include greens fees and use of the range subject to Pro Shop discretion, but no bag storage or locker room access) Juniors (Current members age 12-18 years old. Non-Members age 14-18-years old, $220 for each additional junior). Category (2) Player: Players can play whenever the course is open on weekdays, except on Wednesday when must tee off by 12:00 PM. Saturday tee off after 12:30 PM. Sunday and Holiday tee off after 12:00 noon. $ 540 $ 840 **Junior Adults (Age 19-24 years old $270 for each additional and $320 for each additional nonmember). Category (2) Player: Players can play whenever the course is open on weekdays, except on Wednesday when must tee off by 12:00 PM. Saturday tee off after 12:30 PM. Sunday and Holiday tee off after 12:00 noon. $ 960 $ 1,380 Junior and Junior Adult Memberships allow members to play golf April 1st through December 1st. Dues (Include greens and bag/range fees, pool and tennis. Lockers are available at an additional fee per year. Full membership January through December. Young Adult - (Age 25-30 years old) Discounts for siblings will apply. Category (1) Player: Can play whenever the course is open except on Thursday when they may tee off after 12:00 noon. Eligible for tournaments. $ 2,670 $ 3,080 Health Club Add-On $ 250 $ 250 Locker Fee $ 175 $ 175 Special Assessments (At the discretion of the Board, limit 1 per year) $ 100 $ 100 Cart Fees $ 22 Greens + Guest Fees - Weekdays / Friday, Saturday & Holidays (Limited to 2 Per Month) $55 / $75 $55 / $75 Pool Guest Fees $ 8 $ 8 Minimum Spending (includes food and alcohol) $ 50 $ 50 Cart Rental (Must be 16 years old to drive a cart) $ 22 $ 22 Members will have a charge account (Subject to standard checks by KCC) Yes Yes Eligible for club tournaments in appropriate age divisions Yes Yes Tee times required (Subject to Pro Shop approval) Yes Yes * Administrative Fee on all food and beverage purchases 20% 20% $100 discount if you are on a High School or College Golf team, verification required. **Junior members over 18 years old can buy up into the Young Adult Membership.
Social Memberships Family memberships include spouse and single children living at home through age 25. All family members have access to the following areas of the Club; pool, tennis, health club (optional), and member's private dining room. (There are limitations for children in certain areas.) Social Pool Club Kirkbrae (Includes half locker and golf two times per month for member only with applicable greens/cart fees) Social Dining Voting Rights No No No Payable on Acceptance: Initiation Fee - WAIVED Dues $ 1,300 $ 640 Dues (Includes Bag/Range, Handicap, and Half Locker Fees for Member) $ 2,710 Health Club Add-On for first family member $ 250 Included Health Club Add-On for each additional family member $ 100 Included Minimum Spending (includes food and alcohol) $ 50 $ 100 $ 75 Capital Improvement Fund (for 36 first months of membership) $ 15 Capital Improvement Fund (for first 3 years - payable in January) $ 750 Building Maintenance Plan (for first 60 months of membership) $ 15 $ 25 * Administrative fee on all food and beverage purchases 20% 20% 20% Cart Fees $ 22 Greens + Guest Fees - Weekdays / Friday, Saturday & Holidays (Ltd to - 2 Per Month) $55 / $75 Pool Guest Fees $ 8 $ 8
Corporate Memberships Corporate Golf - Sponsor a minimum of three members who will have access to all areas of the Club. Corporate Social - Sponsor a minimum of four listed employees with dining privileges. Each listed employee is entitled to bring one golf foursome per month any weekday at scheduled rates. Social Family, Health Club, and Range Add-ons available at additional fee. Corp. Golf 3 Minimum 5 Maximum Corp. Social 4 Minimum 10 Maximum Dues (Per Group) $ 10,880 Includes Bag/range, Handicap, and Full Locker for each listed employee Social Family Add-on (Per Employee) Allows spouse and single children living at home through age 25 access to the following areas of the Club; pool, tennis, health club, and member's private dining room. (There are limitations for children in certain areas.) $ 375 $ 375 Health Club Add-On (First User/Add'l User) $250/$100 $250/$100 Range Usage Add-On (First User/Add'l User) $200/$100 Annual Minimum Spending (January to December) Per listed employee for food and alcohol 1,500 $ $ 1,500 Building Maintenance Plan (for first 60 months of membership) $ 25 $ 15 Golf Course Improvement Plan (for first 60 months of membership) $ 25 * Administrative Fee (Automatic on all food and beverage purchases) 20% 20% Cart Rental $ 22 Greens + Guest Fees - Weekdays (Thur. after 12:00 PM) $ 55 Greens + Guest Fees - Friday, Saturday & Holidays (After 11:00 AM) $ 75 Corporate Rate - Weekday Greens & Cart $ 95 Pool Guest Fees $ 8 $ 8 Tournament Eligibility: ABCD Events & One-day member guests Yes No Miscellaneous Fees: Special Assessments (At the discretion of the Board, limit 1 per year) Yes No Voting Rights No No All billing to the company-no individual billing Yes Yes