MEMBERSHIP APPLICATION - RIVER POINTE GC

Name:_______________________________________            Date Of Birth:__________________

Billing Address:     _________________________________________________________________

City/State/Zip:____________________________________________________________________

Please Check Membership Term:  12 months   24 months   36 months   other: ___________

Membership Type:___________________ @  $ _________ per month     +  Initiation Fee: $_____

Corporate / associated with/ employer: _______________________________________________ 

Home Phone: _____________  Daytime Phone: _______________  Cell Phone: _______________

Fax number: ______________ email address: __________________________

Would you like an email notification of your account charges:  Yes   No   

If married, name of spouse _________________         Children: 1)   _____________ DOB________     

Previous Golf Member of  ___________________                     2)   _____________ DOB________

Current Golf Member of    __________________                      3)   _____________ DOB________

Reason for Joining River Pointe:________________________________________________________

Referred by: ______________________________  

Payment Guarantee:

River Pointe Golf requires a credit card on file to charge past due accounts.  

Card # __________________________________________      Expiration Date: ________________

  Visa                     MasterCard                   American Express                        Discover

  (optional) Deduct my monthly River Pointe statement automatically from this credit card

Total Amount paid with this application: $ _________      Form of Payment: __________________

Monthly Fees are billed on the first and due net 30.  A minimum $10 late fee applies to past due accounts. Past due members will have membership privileges suspended and will not qualify for member drawings or specials. An accepted member is obligated for the monthly dues for the full term indicated on this application.  After this period, we require written notification one month in advance if you intend to cancel your membership. Dues are subject to change without prior notice. I agree to the terms and conditions of a River Pointe G.C. Membership .  I will abide by the rules and regulations of the River Pointe G.C.  I will not hold River Pointe G.C. liable for any accidents or injuries.

Member Signature: _______________________________                Date:____________________

Approved by River Pointe: _________________________                Date: ____________________