2023 Intermediate Membership Application

PETERBOROUGH GOLF Membership Application

Your Name

hereby apply for the following membership

Membership

Please select a membership using the dropdown below. (Please click on the box for options

Options

Club Storage Seasonal Fee

Club Storage with Pull Cart

Seasonal Locker

Power Cart: Single Seat Power Cart Unlimit

Member Information

First Name:

Last Name:

Date of Birth:

(Year/Month/Day)

Phone number: Email: Address:

Street Address

Street Address Line 2

City

Province

Postal Code

Country

Payment Information

Credit Card (A 2.25% surcharge will be applied to any balances processed via credit card)

VISA

Master Card

Credit Card Number

Expiry Date

CVV

Name on Card

E-Transfer (No Surcharge. Email: dhayes@ptbogolf.com. Payment to be made at time of submission.)

Member Acceptance & Agreement

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.

I understand the details of all applicable initiation fees submitted with this application.

I understand the details and promise to pay all annual dues/fees/assesments that are applicable to my membership.

I understand the details of House Minimums (food & beverage purchase) scheduled for this application.

I understand to follow all By-Laws and Regulations of the Club and any other resolutions passed by the club.

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.