Application for Membership 2023

NOMINATION/application FOR MEMBERSHIP

Primary Member PROSPECTIVE MEMBER:____________________________________________ DOB:________________________________ FLORIDA ADDRESS:____________________________________________________________________________________ _____________________________________________________________________________________________________ PHONE:_________________________________ EMAIL:_______________________________________________________ OTHER ADDRESS:_____________________________________________________________________________________ HOW MANY MONTHS DO YOU LIVE IN FLORIDA:___________________________________________________________ PRESENT/PAST CLUB MEMBERSHIPS: PRESENT:____________________________________________________________________________________________ PRESENT/PAST:_______________________________________________________________________________________ HAVE YOU (OR SPOUSE) EVER BEEN SUSPENDED/TERMINATED FROM A PRIVATE CLUB OR ORGANIZATION? _____YES _____NO IF YES, EXPLAIN:____________________________________________________________________ _____________________________________________________________________________________________________ EMPLOYER: _______________________________________________________TITLE:______________________________ HOW MANY YEARS?_________ PREVIOUS EMPLOYMENT: ______________________________________________________________________________ EDUCATION:__________________________________________________________________________________________ OTHER NOTABLE POSITIONS: ___________________________________________________________________________ NAMES & BIRTH DATES OF CHILDREN ( UNDER 22 )

WRITE BRIEF RESUME OF YOUR INTEREST – Social, business, hobbies ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________

Spouse PROSPECTIVE MEMBER:____________________________________________ DOB:________________________________ FLORIDA ADDRESS:____________________________________________________________________________________ _____________________________________________________________________________________________________ PHONE:_________________________________ EMAIL:_______________________________________________________ OTHER ADDRESS:_____________________________________________________________________________________ HOW MANY MONTHS DO YOU LIVE IN FLORIDA:___________________________________________________________ PRESENT/PAST CLUB MEMBERSHIPS: PRESENT:____________________________________________________________________________________________ PRESENT/PAST:_______________________________________________________________________________________ HAVE YOU (OR SPOUSE) EVER BEEN SUSPENDED/TERMINATED FROM A PRIVATE CLUB OR ORGANIZATION? _____YES _____NO IF YES, EXPLAIN:____________________________________________________________________ _____________________________________________________________________________________________________ EMPLOYER: _______________________________________________________TITLE:______________________________ HOW MANY YEARS?_________ PREVIOUS EMPLOYMENT: ______________________________________________________________________________ EDUCATION:__________________________________________________________________________________________ OTHER NOTABLE POSITIONS: ___________________________________________________________________________ WRITE BRIEF RESUME OF YOUR INTEREST – Social, business, hobbies ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________

Sponsor for Membership NAME 1: __________________________________________________________________________ NAME 2: ___________________________________________________________________________

Type of Membership : Check one __ Full Golf Single

___Full Golf Couple

__ Limited Play Single

___Limited Play Couple

__ Afternoon Single

___Afternoon Couple

__ Social Single

___Social Couple

* Those choosing a single membership will be given a complimentary Social membership for their spouse. This is required for all members.

Payment Choice for Dues: circle one 1 Payment in Full – Pay by Nov 1 & Receive 3 free guest passes 3 Equal Payments in November, December, January 12 Monthly payments * All members who choose to pay their annual dues on a monthly basis, must either complete an ACH form and have their monthly bill paid automatically from their checking account or pay an annual fee of $250. They acknowledge that the dues are an annual commitment and must be paid in full even if they resign mid-season.

Initiation Fee $25,000 ___ I have attached a check for the full amount of the initiation fee. ___ I wish to pay the initiation fee in the installments and pay a $500 installment fee. (the first installment is $8,334 plus $500 fee = $8834). The next 2 installments are due the following two 1st of Novembers.) ___ I am under 30 and wish to pay over 10 years and pay a $500 installment fee. (the first installment is $2500 plus $500 fee and due with the application) Each additional Installment is due on November 1st

Cart Choice ____Pay per use ____ Unlimited Use of Club Carts ____I have my own cart and will pay a Trail Fee ___ Single ___ Couple

MEMBERSHIP AGREEMENT The privileges and conduct of each member is governed by the Club’s By-laws, and Rules and Regulations, as they may be amended from time to time. This includes but is not limited to, the following: *Members are liable for all annual dues, fees, and charges as of November 1st of each calendar year. *While dues can be billed monthly, member agrees to pay all dues, fees & charges for the entire year. *Membership dues, fees and charges are not refundable or transferable. *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. *As a member, pictures or video may be used for promotional materials in which any member may appear. *I agree to have my picture used for such purposes. *I agree to have my credit report pulled to confirm financial wellness.

I have read the conditions above and if accepted for membership, agree to abide by them.

SIGNATURE OF CANDIDATE________________________________________________DATE_________ SIGNATURE OF SPOUSE___________________________________________________DATE__________ THE UNDERSIGNED DECLARES THAT ALL STATEMENTS MADE, AND SUPPORTING DOCUMENTATION PROVIDED, IN CONNECTION WITH THE REQUEST FOR INVITATION ARE TRUE. THE UNDERSIGNED (PLEASE CHECK ONE) DOES [ ] DOES NOT [ ] AUTHORIZE LOSTCITY GOLF CLUB TO PERFORM, OR TO ENGAGE A THIRD·PARTY(IES) TO PERFORM, SUCH BACKGROUND AND/OR REFERENCE CHECKS ON THE UNDERSIGNED AS LOST CITY GOLF CLUB DEEMS NECESSARY OR APPROPRIATE IN ITS SOLE AND ABSOLUTE DISCRETION. SIGNATURE OF CANDIDATE________________________________________________DATE_________ SIGNATURE OF SPOUSE___________________________________________________DATE__________ THE UNDERSIGNED HEREBY AGREES THAT, IF ACCEPTED FOR MEMBERSHIP IN LOST CITY GOLF CLUB, THE UNDERSIGNED SHALL COMPLY WITH AND SHALL BE BOUND BY All OF THE TERMS AND PROVISIONS OF THE BYLAWS AND THE RULES AND REGULATIONS OF LOST CITY GOLF CLUB AS AMENDED FROM TIME TO TIME, AND, FURTHER, AGREES TO PAY ALL SUMS DUE TO LOST CITY GOLF CLUB ON A TIMELY BASIS IN ACCORDANCE WITH SUCH BYLAWS, RULES OR REGULATIONS OR OTHERWISE, AS ADOPTED OR AMENDED NOW OR IN THE FUTURE. IN THE EVENT THAT LOST CITY GOLF CLUB RETAINS COUNSEL OR INITIATES LEGAL ACTION TO ENFORCE ANY TERMS OF THIS MEMBERSHIP AGREEMENT, THE RULES AND REGULATIONS OR CLUB BYLAWS, THE UNDERSIGNED SHALL BE RESPONSIBLE TO PAY REASONABLE ATTORNEY’S FEES AND LEGAL COST AND EXPENSES INCURRED BY LOST CITY GOLF CLUB IN ADDITION TO THE PAYMENT OF ALL SUMS OWED. SIGNATURE OF CANDIDATE________________________________________________DATE_________ SIGNATURE OF SPOUSE___________________________________________________DATE__________

AMOUNT DUE WITH APPLICATION Non-Refundable Application Fee State Tax Due

$100 $ 7

Current Initiation Fee $25,000 Total Initiation Fee Paid at Application

$

The Initiation Fee may be paid over 3 years in equal installments or applicants under the age of 30 may pay over a term of 10 years. If the member leaves before the entire fee are paid ( voluntarily or involuntarily ), the remaining balance shall be paid at that time they are no longer a member in good standing.

Installment Fee for Choosing to Pay Over Time

Initiation Fee Remaining

$

$500

$___________

I have attached a check for

$__________

Make check payable to Lost City Golf Club Mail to Membership—Lost City Golf Club 301 Orange Tree Drive Atlantis, FL 33462