Application Packet

For Club Use Only Date Received By Club: Effective Date of Membership: New Membership Number:

Worcester Country Club 2 Rice Street | Worcester, MA 01606 508.853.8064 | www.WorcesterCC.org

Worcester Country Club Application for Preview Membership

Worcester Country Club

FAMILY AND OTHER INFORMATION

MEMBERSHIP CLASSIFICATION Application Type: Preview Relationship

Please list children under the age of 25 years old, living at home. Attach an additional sheet as needed.

Desired Membership:  Active Family Member

 Active Single Member

Please select age classification:  Ages 40 & Above Returning WCC Member:

 Yes

 Ages 35 - 39

 Social Member  Ages 30 - 34

 Non-Resident Member

 Male  Female First

Last

Age

Date of Birth

First

Last

Age

Date of Birth

First

Last

Age

Date of Birth

First

Last

Age

Date of Birth

First

Last

Age

Date of Birth

2.

 No

PERSONAL INFORMATION First

 Male  Female

3.

Name Title

1.

 Ages 25 – 29

Middle Initial

4.

Last

Home Address

________ Street

City

State

Zip Code

Street

City

State

Zip Code

Billing Address (if different)

 Male  Female

5.

 Male  Female

Are you a prior member of Worcester Country Club?

 Yes

 No

If so, when? __________________________________

Are you a current or previous member of another country club? If so, please list.

Home Phone Number

Cell Phone Number

Date of Birth

 Single

 Widowed

 Domestic Partnership

REFERRIING WCC MEMBER

Spouse/Significant Other Name Title

First

Cell Phone Number

Middle Initial

If you were referred by a current Worcester Country Club Member, please list their full name below.

Last

_________________________________________

Date of Birth

Spouse/Significant Other Email Address

AUTHORIZATION

PROFESSIONAL INFORMATION Applicant’s Occupation and/or Nature of Business or Profession

 Retired Title

I hereby request to be a preview member of Worcester Country Club. As part of the process, I offer the information requested on this form and recognize that my request may or may not be granted. Furthermore, I agree if the Club approves this application I will conform to and be subject to, the Constitution, Bylaws, and Rules of the Club.

Applicant’s Signature

Date

Business Address Street

Business Telephone Number

City

State

Zip Code

Spouse/Significant Other’s Signature

Date

(if applicable)

Years in Present Employment

College Attended (if applicable) Spouse/Significant Other Occupation and/or Nature of Business or Profession Name of Company

 Retired

Effective Date of Membership:

Business Address Business Telephone Number College Attended (if applicable)

For Club Use Only Date Received By Club:

Title

Street

 No

Please list by name any relatives who have been or currently are members of Worcester

Please fill out the Spouse/Significant Other information below, if applicable.

Name of Company

 Yes

Club Information (Name, Phone Number)

Email Address

 Married

 Male  Female

City

State

Years in Present Employment

Zip Code

New Membership Number:

Worcester Country Club

FAMILY AND OTHER INFORMATION

MEMBERSHIP CLASSIFICATION Application Type: Preview Relationship

Please list children under the age of 25 years old, living at home. Attach an additional sheet as needed.

Desired Membership:  Active Family Member

 Active Single Member

Please select age classification:  Ages 40 & Above Returning WCC Member:

 Yes

 Ages 35 - 39

 Social Member  Ages 30 - 34

 Non-Resident Member

 Male  Female First

Last

Age

Date of Birth

First

Last

Age

Date of Birth

First

Last

Age

Date of Birth

First

Last

Age

Date of Birth

First

Last

Age

Date of Birth

2.

 No

PERSONAL INFORMATION First

 Male  Female

3.

Name Title

1.

 Ages 25 – 29

Middle Initial

4.

Last

Home Address

________ Street

City

State

Zip Code

Street

City

State

Zip Code

Billing Address (if different)

 Male  Female

5.

 Male  Female

Are you a prior member of Worcester Country Club?

 Yes

 No

If so, when? __________________________________

Are you a current or previous member of another country club? If so, please list.

Home Phone Number

Cell Phone Number

Date of Birth

 Single

 Widowed

 Domestic Partnership

REFERRIING WCC MEMBER

Spouse/Significant Other Name Title

First

Cell Phone Number

Middle Initial

If you were referred by a current Worcester Country Club Member, please list their full name below.

Last

_________________________________________

Date of Birth

Spouse/Significant Other Email Address

AUTHORIZATION

PROFESSIONAL INFORMATION Applicant’s Occupation and/or Nature of Business or Profession

 Retired Title

I hereby request to be a preview member of Worcester Country Club. As part of the process, I offer the information requested on this form and recognize that my request may or may not be granted. Furthermore, I agree if the Club approves this application I will conform to and be subject to, the Constitution, Bylaws, and Rules of the Club.

Applicant’s Signature

Date

Business Address Street

Business Telephone Number

City

State

Zip Code

Spouse/Significant Other’s Signature

Date

(if applicable)

Years in Present Employment

College Attended (if applicable) Spouse/Significant Other Occupation and/or Nature of Business or Profession Name of Company

 Retired

Effective Date of Membership:

Business Address Business Telephone Number College Attended (if applicable)

For Club Use Only Date Received By Club:

Title

Street

 No

Please list by name any relatives who have been or currently are members of Worcester

Please fill out the Spouse/Significant Other information below, if applicable.

Name of Company

 Yes

Club Information (Name, Phone Number)

Email Address

 Married

 Male  Female

City

State

Years in Present Employment

Zip Code

New Membership Number:

WORCESTER COUNTRY CLUB

“Discover Worcester Country Club ” Prospective Member Preview Relationship Agreement Conditions of Preview Relationship: I,

, hereby apply to preview the following membership:     

Active Member(ages40andabove) Active Member(ages30-34) Social Member(ages40 and above) Social Member(ages30-34) Non-Resident Member(ages 25-29)

   

Active Member(ages35-39) Active Member(ages25-29) Social Member(ages 35-39) Social Member(ages 25-29)

I understand there shall be no initial initiation fee due upon submission of my Application for Prospective Preview Membership in conjunction with my Preview Relationship Term. By electing to join in a provisional Preview Relationship, I agree to the following terms/conditions as they relate to joining Worcester Country Club.

1. Commitment to Relationship for a Minimum Preview Term of 12 Months. I hereby obligate myself for the payment of all applicable monthly dues, monthly capital assessment, dining minimums and other customary fees and all charges during my minimum 12-month Preview Relationship Term, subject to the terms associate with the “Discover Worcester Country Club Prospective Membership Preview Initiative.

2. Termination of Privileges or Membership Continuation at Conclusion of the 12-Month Preview Relationship Term. After my 12-Month Preview Relationship Term has concluded, all of my privileges hereunder shall terminate unless I elect to apply for Membership in the club, subject to the Club’s standard new Member procedures, with such process commencing approximately nine (9) months into the term of the Preview Relationship.

3. On or before the 60th day of the Preview Relationship Term, I may pay the “Discover Worcester Country Club” Prospective Preview membership Initiative Preferred Initiation Fee for the applicable membership category shown below.

Membership Classification Active Member(ages 40 &above) Active Member(ages 35-39) Active Member(ages 30-34) Active Member(ages 25-29) Social Member(ages 40 &above) Social Member(ages 35-39) Social Member(ages 30-34) Social Member(ages 25-29) Non-Resident Member

Current Initiation Fee $10,000 $7,500 $5,000 $2,500 $2,000 $1,500 $1,000 $500 $10,000

Preferred Initiation Fee $6,000 $4,500 $3,000 $1,500 $1,200 $900 $600 $300 $6,000

“Discover Worcester Country Club �

Prospective Member Preview Relationship Agreement

Should I choose not to pay the Preview Initiation Fee 60 days into the Preview Term and join the club in accordance with #2 above, I will be obligated to pay the Initiation Fee in full for the applicable category of membership as shown below.

Membership Classification Active Member(ages 40 & above) Active Member(ages 35-39) Active Member(ages 30-34) Active Member(ages 25-29) Social Member(ages 40 & above) Social Member(ages 35-39) Social Member(ages 30-34) Social Member(ages 25-29) Non-Resident Member

Current Initiation Fee $10,000 $7,500 $5,000 $2,500 $2,000 $1,500 $1,000 $500 $10,000

4. Privileges and Limitations During Preview Relationship Term. During my Preview Relationship Term I shall be entitled to the use of the Club facilities and involvement in all Club activities (excluding major Club tournaments/events as determined by Worcester Country Club) and usage privileges in the category of membership in which I am approved. Additionally, I understand my Preview Relationship is not transferable not refundable except as stated in #6 below.

5. Worcester Country Club By-Laws and Rules and Regulations. I agree to be bound by the Worcester Country Club By-Laws and Rules and Regulations as established and may be amended by Worcester Country Club, from time to time.

6. Revocable Relationship. The Club has the absolute right and discretion to revoke my Preview Relationship at any time before the Preview Relationship Term (12 months) concludes. If the Club exercises its right, I remain obligated and promise to pay all applicable dues, fees and all charges incurred through the date on which the Club exercises its right to revoke my membership. If I have paid the Preferred Initiation Fee, the Preferred Initiation Fee will be refunded to me, without interest, within 30 days, subject to my payment of all current obligations through the date of revocation.

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“Discover Worcester Country Club ” Prospective Member Preview Relationship Agreement 1. Payments. All monthly dues, capital assessments, dining and other charges shall be paid within fifteen (15) days of the billing date via automatic bank payment. In addition, the Club maintains a backup credit card authorizations to be used only in the event the bank payment fails. Please provide the following: ACH Bank Information Bank Name: ____________________________________________________________________________ Routing number: ________________________________________________________________________ Type of account: ________________________________________________________________________ Account number: ________________________________________________________________________ Your authorization signature: ______________________________________________________________

Credit Card Authorization. I agree to maintain a current credit card account on file with the Club at all times.

Card Type _____________ Account Number __________________________________________________ Expiration Date ______/______

3 Digit Security Code ________

Applicant’s Name ________________________________________________________________________ (please print)

Signature _____________________________________________________ Date ____________________

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WORCESTER COUNTRY CLUB AUTHORIZATION TO OBTAIN INFORMATION

In connection with my proposal for membership and/or my membership application to Worcester Country Club (WCC), a private entity, of Worcester, MA, I understand that WCC conducts due diligence and fact checking of information provided to WCC by me and/or my member sponsors.

Information contained within the proposal and/or application for membership is relied upon by the WCC Membership Committee to determine suitability for membership at WCC. I understand and consent by signature below to this type of inquiry by WCC and affirm that all information I have provided to WCC for membership consideration is true and correct.

I, ________________________________________, hereby authorize any person and/or entity contacted by WCC, or their designee, to release information sought or requested about me to WCC in connection with my membership proposal/application and I hereby release and hold harmless any person and/or entity from liability for having provided the information requested by WCC or their designee.

I further authorize that a photocopy/scan of this release and authorization be honored as if it were the original.

____________________________________ PRINT NAME

______-____-______ SSN

______________ DOB

___________________________________________________________________________ ADDRESS ___________________________________________________________________________ CITY STATE ZIP

_______________________________ SIGNATURE

____________________________________ DATE

May 2019