Street Address Line 2
(A 2.25% surcharge will be applied to any balances processed via credit card)
Please fill in your initials to identify the acceptance of the following statements.
In the event of a delinquent account as per our club bylaw 5.3.2. “Any Member that shall neglect or fail to pay the prescribed Annual Fee, the initiation Fee, any assessment levy, house account or any other indebtedness to the Club for more than sixty days after the same shall be due, the Board may, without notice, withdraw all privileges of such member.”
Any indebtedness past 60 days, the club has the right to charge my credit card
plus 2.25% service charge to avoid the withdrawal of my privileges.
I have read and understand the terms and conditions of the past 60 days indebtedness, as indicated above.
By submitting form, I verify that all statements on this application are true. Please hit the submit button only once. You will receive a notice once the form is accepted.