NOMINATION FOR MEMBERSHIP
PERSONAL INFORMATION Name __________________________________________________________________________________________ Title
First
Middle Initial
Last
Nickname
Home Address __________________________________________________________________________________ Street
City
Home Phone Number _________________________
State
Zip Code
Mobile Phone Number _______________________________
Date of Birth ________________________________________ Email Address _______________________________________________________________________________________ Single
Married
Divorced
Widowed
If married, please fill out the Spouse information below.
BUSINESS INFORMATION Nominee’s Occupation and/or Nature of Business or Profession ___________________________________ Retired Name of Company _________________________________________ Title _____________________________________
Business Address ________________________________________________________________________________ Street
City
State
Zip Code
Business Telephone Number ________________________________ Years in Present Employment __________________ Education Background ________________________________________________________________________________
SPOUSE PERSONAL INFORMATION
Spouse Name ___________________________________________________________________ Title
First
Middle Initial
Last
____________ Nickname
Mobile Phone Number_________________________________ Date of Birth ____________________________________ Spouse’s Email Address _______________________________________________________________________________
Spouse’s Occupation and/or Nature of Business or Profession _________________________________________________ Name of Company _________________________________________ Title _____________________________________
Business Address ________________________________________________________________________________ Street
City
State
Zip Code
Business Telephone Number ________________________________ Years in Present Employment __________________ Education Background ________________________________________________________________________________
AFFILIATIONS What is the number one reason you are joining Lost City Golf Club? _________________________________________________
Is the Nominee a prior member of Atlantis Golf Club or Lost City Golf Club:
Yes
No
If so, when? _________________________________________ What is the number one reason you are renewing your membership? __________________________________________________ Is the Nominee a current or previous member of another country club?
Yes
No
If so, please list: Club Information (Name, Phone Number): ______________________________________________________________________ Membership in Business, professional, Civic and Fraternal Organizations: _____________________________________________
SPONSOR INFORMATION Sponsor: ______________________________________________________ Please print Name and Member Number
Sponsor: ______________________________________________________
___________________________________ Signature
___________________________________
TYPE OF MEMBERSHIP FULL GOLF LIMITED PLAY AFTERNOON SOCIAL WELCOME SUMMER PGA
SINGLE or COUPLE CIRCLE ONE SINGLE or COUPLE CIRCLE ONE SINGLE or COUPLE CIRCLE ONE SINGLE or COUPLE CIRCLE ONE SINGLE or COUPLE CIRCLE ONE SINGLE or COUPLE CIRCLE ONE
AGE CATEGORY: 55 & Over 40-54 Under 40 Payment Choice for Dues: 1 Payment in Full 3 Equal Payments in November, December, and January 12 Equal Payments – Each due at the first of each month Cart Choice Per Use Unlimited Use of Club Carts Have Our Own Cart – Trail Fee
SINGLE or COUPLE circle one
MEMBERSHIP AGREEMENT
The privileges and conduct of each member is governed by the Club’s By-laws, Policies and Rules and Regulations, as they may be amended from time to time. This includes the following: 1. Members are liable for all annual dues, fees, and charges as of November 1 st of each calendar year. 2. While dues can be billed monthly, member agrees to pay all dues, fees & charges for the entire year. 3. Membership dues, fees and charges are not refundable or transferable. 4. While the initiation fee may be payable in installments, member agrees to pay the entire initiation fee within the terms outlined to them and agreed upon, by signing below. I have read the conditions above and if accepted for membership, agree to abide by them. _____________________________________________________________ Signature Date ________________________________________________