2023 Summer Membership Application

PERSONAL INFORMATION

First Name ____________________Last_____________________

Address _______________________________________________

City _____________________ St_____ Zip ___________________

Cell Phone ____________________________________________

Email ________________________________________________

DOB _________________________________________________

Spouse ( If joining as a Couple )

First Name ____________________Last_____________________

Cell Phone ____________________________________________

Email ________________________________________________

DOB _________________________________________________

____ We are a Couple $5,000 fee

Summer fee includes an 18 hole cart per day.

Service Fee

Each summer member must pay a $200 service fee. This replaces the 20% gratuity on all food and beverage.

Total Due for a Single is $3959.00 ( Includes tax ) with the application

Total Due for a Couple is $5778.00 ( Includes tax ) with the application

The summer season runs from May 1st to October 31st .

Make check payable to : Lost City GC

301 Orange Tree Dr. Atlantis FL 33462

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 fees, and charges.

2. Membership dues, fees and charges are not refundable or transferable.

3. 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.

4. I agree to have my credit report and/or background report pulled for review.

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

Signature Date _____________________________________________________________

Signature Date