AMELIA NATIONAL GOLF CLUB

APPLICATION FOR MEMBERSHIP PRIVILEGES (INDIVIDUALS)                                              

AMELIA NATIONAL TENNIS & GOLF CLUB APPLICATION FOR MEMBERSHIP PRIVILEGES (INDIVIDUAL) The  undersigned  hereby  applies  for  membership  and  the  resultant  use  privileges  at  Amelia  National  Golf  Club.    Any  capitalized   terms  not  otherwise  defined  herein  shall  have  the  meaning  ascribed  to  them  in  that  certain  Plan  for  the  Offering  of   Memberships  dated  February  2005.    If  accepted,  the  undersigned  requests  that  their  name  be  placed  on  the  Membership   Roster  as  follows.  

MEMBER INFORMATION Mr.     Mrs.   Ms.     Miss   Name  of  Applicant/Member  (Please  Print):   *(PRIMARY  MEMBER)    

 

Dr.

 

Home  Address       Street         City   State     Social  Security  #     Date  of  Birth   Driver’s  License  #     State   Marital  Status:    Single   Married   Wedding  Date   Name  of  Employer   Occupation  and/or  Nature  of  Business   Title     Years  in  Present  Employment   Business  Address     Street             City   State   Business  Telephone  #  (___)     Fax  #  (___)   Home  Telephone  #  (___)     E-­‐Mail  Address   Please  Mail  Club  Billings  To:   Home   Business   Please  Mail  All  Other  Club                          Correspondence  To:     Home   Business     *In  any  dispute  regarding  membership,  the  PRIMARY  MEMBER  retains  privilege.  

      Zip                   Zip      

Mr.     Mrs.   Ms.     Miss   Dr.     Spouse’s  Name   Social  Security  #     Date  of  Birth   Driver’s  License  #     State   Name  of  Employer   Occupation  and/or  Nature  of  Business   Title     Years  in  Present  Employment   Business  Address     Street             City   State   Business  Telephone  #  (___)     Fax  #  (___)     DEPENDENT INFORMATION

                Zip    

Unmarried  children  who  are  under  the  age  of  twenty-­‐one  and  either  living  in  the  member’s  home,  attending  school  on  a   full-­‐time  basis,  or  serving  in  the  military:  

Name  (First  &  Last)     1.   2.   3.   4.  

       

Date  of  Birth          

         

Male            

Female                    

       

  REFERENCES CLUB/SOCIAL  REFERENCES     1.       Name  of  Club/Organization         City   State   Member       Are  you  in  good  standing?    Yes                      No     If  no,  please  explain       2.       Name  of  Club/Organization         City   State   Member       Are  you  in  good  standing?    Yes                      No     If  no,  please  explain    

  Year  Accepted     Present/Former  

 

 

   

Year  Accepted     Present/Former  

 

 

 

  PERSONAL  REFERENCES     1.       Name   Telephone  #   Years  Known             Street             City   State   Zip     2.       Name   Telephone  #   Years  Known             Street             City   State   Zip     BANK/CREDIT  REFERENCES               Name  of  Institution   Branch   Officer  to  Contact     1. Application for Membership Privileges. The undersigned hereby applies for a membership at Amelia National Golf Club and agrees to pay the following membership deposit/fee to the Club by marking the box below:  

Amelia National Golf & Country Club

   

Membership   Classification      Premier  Membership      National  Membership  

                 

   Lifestyle  Membership  

Membership   Deposit/Fee  

  $___________  Deposit  Fee     $___________  Sales  Tax     $___________  Total              

           

 

 

Amelia National Tennis Club     Membership   Classification      

   Family      Couple  

     

   Single      Junior      Snow  Bird    

             

Membership   Deposit/Fee     $___________  Deposit  Fee     $___________  Sales  Tax     $___________  Total                

   

• Initiation Fees are non-refundable • Dues paid 12 months in advance receive a 5% discount. • Seniors and Military servicemen/ women and their families receive a 20% discount on dues. Senior discount may only be applied to Single and Couple Memberships. • Junior is under 18 and Senior is 55 and older • Snow Bird Membership begins November 1st and ends April 1st

*By  filling  out  this  membership  application,  a  signature  means   the  applicant  has  read,  understands,  and  will  follow  the  rules   and  regulations  set  forth  by  the  Amelia  National  Tennis  Club.  

 

*All  Checks  must  be  made  out  to  Amelia  National  Tennis  LLC  

  1. Payment of Membership Deposit/Fee. The undersigned hereby acknowledges and agrees that the required membership deposit/fee set forth above in Section 1, plus all applicable taxes, shall be paid to the Club in accordance with the undersigned’s Membership Agreement. 2. Use Privileges at Amelia National Golf Club; No Ownership Interest in the Club or the Club Facilities. The undersigned acknowledges that the Club Facilities provided at Amelia National Golf Club are being constructed and will initially be operated by Amelia National Golf Club, LLC, a Florida limited liability company doing business as Amelia National Golf Club (the “Club”). The Club Facilities will be owned by Amelia National Enterprise, LLC, a Florida limited liability company. The undersigned further acknowledges that the membership privileges at Amelia National Golf Club permit the undersigned to use the Club Facilities in accordance with the classification of membership obtained by the undersigned described above, but is not an investment in the Club or the Club Facilities provided at Amelia National Golf Club, nor does it confer on the undersigned any equity or ownership interest or any other property interest in the Club or the Club Facilities provided at Amelia National Golf Club. Membership privileges at Amelia National Golf Club do not grant to the undersigned a vested or prescriptive right or easement to use the Club Facilities provided at Amelia National Golf Club, but grants to the undersigned a non-exclusive revocable license to use the Club Facilities provided at Amelia National Golf Club, in accordance with the Membership Plan, as it may be amended from time to time. Upon suspension or expulsion, or other termination of the membership held by the undersigned, all of the privileges of the undersigned to use the Club Facilities and to enjoy the privileges at the Club associated with the membership shall cease and terminate. 3. Payment of Club Membership Account. Dues shall be payable in advance annually as provided in the Membership Plan. All fees, food, beverage, merchandise, services and other charges of the Club charged to the member’s Club account will be billed monthly and shall be due upon receipt and shall be deemed delinquent if not paid by the twentieth day of the month in which the statement was mailed. The undersigned hereby agrees and covenants to pay all dues, fees and other charges incurred by the undersigned, immediate family members and their guests and to pay the Club account when due. Past due bills will accrue a late fee each month in an amount equal to a minimum late fee established by the Club from time to time and/or interest at the maximum, non-usurious rate permitted by law from the date of the statement until paid in full. The undersigned further agrees to pay all reasonable attorneys’ fees, investigation fees and other costs incurred in connection with the collection of delinquent accounts. The membership card(s) shall remain the property of the Club at all times and shall be returned to the Club upon request. 4. Receipt of Membership Plan. The undersigned hereby acknowledges receipt of the Plan for the Offering of Memberships at Amelia National Golf Club and the Rules and Regulations dated February, 2005 (collectively, the “Membership Plan”), and agrees to abide by all of its respective terms and conditions as amended from time to time. The undersigned hereby acknowledges and understands that Amelia National Golf

Club, LLC, doing business as Amelia National Golf Club (collectively, the “Club”), will initially operate the Club Facilities to be provided at Amelia National Golf Club. Amelia National Enterprise, LLC is constructing and will own the Club Facilities to be provided at Amelia National Golf Club. 5. Disclosure and Release of Information. Upon signing this Application for Golf Membership Privileges, the undersigned applicant authorizes the disclosure and release of information to Amelia National Golf Club for investigating the undersigned’s qualifications for membership, authorizes those persons or entities herein to furnish information to Amelia National Golf Club and authorizes Amelia National Golf Club to order a consumer credit report. 6. Subject to Payment of Fees. The undersigned understands that use privileges at Amelia National Golf Club are subject to approval and payment of the required dues, fees and charges. 7. Governing Law. This Application for Membership Privileges shall be governed by and construed in accordance with the laws of the State of Florida without regard to principles of conflicts of law.

Date:    

   

  Date:    

     

Signed:       Applicant/Member     Signed:       Applicant’s  Spouse  

 

 

 

 

  FOR CLUB USE ONLY This  Application  for  Membership  Privileges  shall  not  be  binding  on  Amelia  National  Golf  Club  until  the  acceptance  below  is   signed.  

Amelia  National  Golf  Club,  LLC   d/b/a  Amelia  National  Golf  Club     Accepted  on  

   

      By:  

 

 

 

Member  Acct.  #     Membership  Deposit     $     $    

  Resignation  Date  

  Date  Received:       Date  Received:    

  Transfer  Payment  

  By:       By: