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Black Rock Creek Golf Club

Application for Membership

Applicant_____________________________________________

Spouse_______________________________________________

Address______________________________________________

City____________________________State_______ Zip______

Home Phone__________________ Work Phone____________

Email________________________ Fax ___________________

Child's Name_______________________ Age ______________

Child's Name_______________________ Age _____________

I the undersigned agree that membership status in the Black Rock Creek Golf Course

entitles me to full rights and responsibilities. I understand that if I do not renew my membership by March 1, I will pay regular greens fees. I also understand that with Black Rock Creek Membership status, I incur definite liability and responsibilities to pay the full amount of annual dues agreed upon within the established time limit.

You may choose to pay membership fees in three installments. One-Third due February 1, One-Third due April 1, and the final payment Due June 1. Any member with dues not paid in full by June 1 will be required to pay green fees and membership privileges will be suspended until dues are paid in full. Black Rock Creek also has a monthly auto debit program with a $5.00 monthly fee. I understand that a $30.00 administration fee will be charged on all accounts not paid in full by April 1.

Signature:__________________________________________ Date:_______________

Black Rock Creek Golf Club

Membership Fee Schedule

Couple Membership $1,490.00 Junior Membership (18 and under) $ 150.00

Single Membership $1,000.00 College Membership $ 250.00

Auto-Pay Membership-Couple $1,550.00 Member Handicap (non-member- $36.00)$ 26.00

Auto-Pay Membership-Single $1,060.00 Cart Storage and Trail Fee (members only)$ 425.00

Child/Grandchild(age12-18w/ member)$ 75.00/ch. Season Cart Pass $ 425.00

Sub-Total of Memberships and Fees $_________

Sales Tax ( 7.9% ) $_________

Total Due $_________

Men's Golf Association Dues $ 35.00

Total Submitted with Application $____________

Terms of Installment Payments

I elect to pay the total membership fees in three equal installments as indicated below. I understand a

$30.00 Administration fee will be added.

1/3 Due February 1 1/3 Due April 1 1/3 Due June 1

Signature______________________________________________ Date________

_____________________________________________________________________________________

All members will have a range pass.
All prices are subject to Sales Tax.
Visa and MasterCard are accepted.
All memberships are non-transferable and non-refundable.
Any member who has not renewed their membership by March 1 will nolonger be considered a member and will be charged green fees.
An administration fee of $ 30.00 will be added to all accounts not paid in full by April 1.
Any member with dues not paid in full by June 1 will be required to pay green fees and membership privileges will be suspended until duesare paid in full. If dues are not paid by July 10, further action will be taken.

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