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. The attached questionnaire is stored in BGCC s database and utilized to better accommodate your membership needs and arrange activities accordingly. Please be assured that BGCC s management respects your right to privacy and never sells information or mailing lists to anyone. Mr. Mrs. Ms. Miss Dr. Applicant Name: Date of Birth Prime/Silver Sneakers only: Prime Silver Sneakers # Mailing Address: Zip: Occupation: DL#: Phone Numbers: E-mail address: Home: Work: Cell: Mr. Mrs. Ms. Miss Dr Spouse name: Date of Birth Prime/Silver Sneakers only: Prime Silver Sneakers # Occupation: Phone Numbers: Home: Work: Cell: E-mail address: Dependants: (Unmarried Children under 19 years of age living at home or attending school) (1) Date of Birth: Gender: (2) Date of Birth: Gender: (3) Date of Birth: Gender: (4) Date of Birth: Gender: Members are responsible for all charges incurred by dependants.
What influenced your decision to choose Brooksville Golf & Country Club? Would you like to establish a handicap here? Yes No If Yes, names of family members for handicap:. Monthly statements are provided via email unless postal mail is requested. Please provide the email address for statements. Thank you for your interest in the Brooksville Golf & Country Club.
TERMS RECEIPT OF MEMBERSHIP: I/WE ( Member ) have applied for membership indicating the specific membership program noted at Brooksville Golf & Country Club. I hereby acknowledge receipt of the Membership Plan according to the rules and regulations administered and promulgated from time to time by Brooksville Golf & Country Club. I am subject to such rules, terms and conditions set forth as stated. Violation or failure to abide by membership conditions may result in termination or suspension of membership. MEMBERSHIP: Brooksville Golf & Country Club remains sole owners and operators of the Club facilities, including all amenities provided. I hereby acknowledge that my membership does not award me any investment, equity or ownership interest in the Club facilities. Nor does it deem me a vested party with easement to use the Club facilities. Members reserve no right where assets or negotiations are concerned. The Club reserves the exclusive right and discretion to modify the Membership Plan or make any other alterations in the terms and conditions of the membership or the Club facilities and to restrict or reserve usage of the Club facilities for maintenance, golf or tennis tournaments, promotional, charitable or other special events periodically. All memberships are subject to suspension and revocation with or without cause. In the event of any grievance or suit, between the Club and any member for any claim or matter, the prevailing party shall be liable to the other party for all costs and expenses including attorney s fees (including appellate proceeding costs). Resignation from the club must be submitted in writing and provide 30 days advance notice. All resignations will become effective on the 1st day of the month following the 30 days advance notice. PAYMENT AGREEMENT: I hereby understand and agree that this contract is legally binding upon signing. All new memberships require payment of the first and last month's dues. I have read the contract and payment terms of obligation based on the chosen membership. I commit to the payment of the above amount in monthly installments unless annual prepayment arrangements were approved, received, accounted for and cleared. I further agree to be jointly and severally responsible for all charges and expenses incurred by other authorized family members and guests. I acknowledge that all dues and charges are payable automatically by credit card on the 7 th of each month. If the amount due is not received, the account will be considered delinquent, and club privileges will be suspended. The member will subsequently remain liable for the balance due, and all said discretionary fees and charges of the collections process will become the responsibility of stated member. In the event of failure to pay any amounts due to the Club, the Membership Fee or any portion thereof paid previously for the membership will be liquidated and all entitlement will be subject to the Club s discretion. HOLD HARMLESS: I acknowledge the possibility of injury and risks associated with usage of the Club facilities. Every member shall be liable for any property damage and/or personal injury at the Club facilities, or any event or function that is coordinated, operated arranged or sponsored by the Club, caused by the member, any family member or guest. The cost of any such damage will be charged to the member s account. WAIVER AND RELEASE OF LIABILITY: The Club urges and recommends you and all members to obtain a physical examination from a licensed physician before using any equipment or participating in any exercise program. All exercises or activities performed with or without the use of equipment or apparatus designed for exercise is at the member s sole risk. The member assumes entire responsibility when using or selecting exercise programs, including selection of methods and types of equipment used. The Club shall not be liable to member for any negligence, claims, demands, injuries, damages, or actions causing injury to member s person or property arising out of or in connection with the use by member of the services, facilities, and premises of the Club. The member is advised that personnel have no expertise in diagnosing, examining or treating medical conditions of any kind or effect of any specific exercise on said medical condition. Member fully understands and agrees that in consideration of participating in one or more of the fitness programs or using the facility, there is the possibility of accidental or other physical injury. Member agrees to assume the risk of injury and further, member hereby holds the club, its officers, owners, agents and employees harmless from all claims which may be brought against them by member or on member s behalf for any such injuries or claims. NO BAILOR/BAILEE RELATIONSHIP: The parties hereto agree that this agreement shall not create a bailor/bailee relationship as to any personal property left or held by or at the club, including, but not limited to, clothing, workout equipment, automobiles and car keys. Members are solely responsible for the security of their property brought onto or into the club premises and/or parking lot. This agreement is performable in Hernando County, Florida. Within this agreement the singular shall include the plural, and the masculine the feminine. Member understands that this agreement shall be binding until resignation according to the rules and regulations of BGCC or until membership is terminated by BGCC pursuant to the rules and regulations of the Club. Signed this day of,. Adult Member #1 Name (please print) Signature Adult Member #2 Name (please print) Signature
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MEMBERSHIP DUES STRUCTURE Please indicate which level of membership you are requesting and any additional amenities by placing a check in the appropriate box(s). Membership Options Annual Dues Monthly Dues PLATINUM MEMBERSHIP* Golf with cart, includes all social membership amenities Individual $ 3750.00 $ 335.00 Family $ 5525.00 $ 485.00 Golf with private cart, includes all social membership amenities (must sign Hold Harmless Agreement) Individual $ 3475.00 $ 299.00 Family $ 4975.00 $ 449.00 GOLD MEMBERSHIP* Golf only, no cart, includes all social membership amenities Individual $ 2250.00 $ 210.00 Family $ 2925.00 $ 255.00 SEASONAL MEMBERSHIP* Individual Family (must be consecutive months) Gold Platinum Gold Platinum 3 months $ 925.00 $1275.00 $1150.00 $1875.00 4 months $1125.00 $1650.00 $1475.00 $2450.00 5 months $1325.00 $1995.00 $1800.00 $2995.00 (Monthly) $ 295.00 $ 425.00 $ 370.00 $ 615.00 6 months $1525.00 $2325.00 $2125.00 $3475.00 (Monthly) $ 280.00 $ 415.00 $ 355.00 $ 595.00 SILVER MEMBERSHIP (Discount Card, Golf only) $499.00 - an individual golf membership - preferred tee times year-round $25.00 before 2pm $20.00 after 2pm - discounted range balls - all rates based on sharing a cart - guest rates not applicable ADDITIONAL GOLF AMMENITIES Monthly Club Cart Rental - Individual $ 145.00 Monthly Club Cart Rental - Family $ 259.00 Private Cart Monthly Trail Fee - Individual $ 125.00 Private Cart Monthly Trail Fee - Family $ 199.00 Daily Club Cart Rental(per person) $ 15.00 per use Handicap Fee(per member) $ 25.00 annually
Membership Options Annual Dues Semi-Annual Dues Monthly Dues SOCIAL MEMBERSHIP* Family $ 660.00 $ 340.00 $ 59.00 Individual $ 420.00 $ 220.00 $ 39.00 3-MONTH SUMMER SOCIAL MEMBERSHIP Individual $135 Family $209 (begins May, June or July only) PRIME/SILVER SNEAKERS No Charge No Charge No Charge All dues and fees are subject to the 6.5% Florida sales tax and will be charged on a credit card on the 7 th of each month. All memberships require enrollment in the automated debit payment program. All dues and fees are payable on the 7 th of each month by credit card, and are subject to change. All membership renewals are subject to approval. All pricing is subject to change without notice.
Photo Release Please Read Carefully Rev. 10/2017 I irrevocably authorize A&M KANG, LLC d.b.a. Brooksville Golf & Country Club, to use for any lawful purpose, photographs and/or pictures of my image or likeness to be used in any website, newsletter, and any other marketing literature to be viewed by the public sector. I waive any right I have to inspect, approve all advertising or copies that may be used in connection with the publication of our website, newsletter, and/or any other marketing literature that may be viewed by the public sector. I hereby release and forever discharge A&M KANG, LLC d.b.a. Brooksville Golf & Country Club from any liability. I have read, and fully understand this Release. I certify that I am 18 years old or if under 18 the parent/guardian fully understands the Release of the photographs to be used in the country club s website, newsletter, and any other marketing literature to be viewed by the public sector. I authorize: Membership # Primary Spouse Child/Children Decline (Please check appropriate categories.) Primary Signature Spouse Signature Guardian of Child/Children (If under 18 years old) Date
BROOKSVILLE COUNTRY CLUB Rev. 10/2017 SWIMMING POOL HOLD HARMLESS AND IMDEMNITY AGREEMENT THIS AGREEMENT is entered into by and between A&M KANG, LLC, herein called the Club, and the undersigned duly registered Club member. WHEREAS, the Club owns and operates a swimming pool for the convenience and use of its members and their guests, and WHEREAS, the Club is legally bound to comply with all statutory laws and regulations with respect to maintenance and operation of the swimming pool, and WHEREAS, the Club has purchased insurance coverage to protect it from liability for accidents or injuries relating to or arising out of the use of the swimming pool. The pool facilities are periodically inspected by safety engineers to establish required safety precautions. The Club becomes liable if such standards and procedures are not applied or enforced, and WHEREAS, each Club member using the swimming pool must be familiar with the swimming rules and procedures prescribed by the Club. Copies are available at the Club office and WHEREAS, the swimming pool is not equipped for night-time swimming. swimmers are allowed to use the pool after dark, and No WHEREAS, adult supervision is required for children under age 16, and WHEREAS, the pool gate must be locked at all times except during posted hours, and WHEREAS, upon signing this Agreement the undersigned member with the distinct understanding that use of the pool is AT THEIR OWN RISK. WHEREAS, the undersigned member agrees that he/she will hold harmless and indemnity the Club for any injury or accident to swimmers using the pool, and for any out-ofpocket expenses incurred by reason thereof, including any expenses or attorney fees that the Club may incur in defending any claim, judgment or other action as a result of such injury or out-of-pocket expenses of the member, and NOW THEREFORE, the undersigned acknowledges that he/she has read the above Agreement and agrees to the terms set forth herein. Date (signed) Member # (signed) Member #
Brooksville Golf & Country Club 23446 Links Drive, Brooksville, FL 34601 Tel (352) 796-8236 Fax (352) 796-9892 www.brooksvillecc.com Credit Application Member Name: Member Number: Credit Card Number: Expiration Date: Type of card? VISA MasterCard Discover American Express Credit or Debit I authorize Brooksville Golf & Country Club to charge the referenced credit or debit card each month for my monthly charges and membership dues. I understand that my card will be automatically charged on the seventh of each month. This payment arrangement will continue until the Club is notified in writing. Member Signature Date Comments: