Please print this page and mail/bring your copy to the club! There are two pages.
Membership Application 2011
(Please Print)
Applicant: _____________________________
Spouse: _______________________________
Address: ______________________________
City: _______________State: ____Zip: _________
Home Phone: _______________Work/Cell: ____________
Email: ______________________
Childs Name: ________________ Age: _______
Childs Name: ________________ Age: _______
Childs Name: ________________ Age: _______
Cart Shed# ____________
Ø I the undersigned agree that membership status in the Black Rock Creek Golf Course entitles me to full rights, privileges and responsibilities.
Ø I understand that if I do not renew my membership by March 1, 2011 I will pay regular greens fees.
Ø 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.
Ø You may choose to pay membership fees in three installment payments. 1/3 due February 1, 1/3 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 debit/credit program with a $5.00 monthly fee.
Ø All grill charges past due will be assessed a service charge of 5.00 each month they are past due.
Signature ____________________ Date_____________
Black Rock Creek GC
2011 Fees
(Please Circle)
Single Membership (Includes Range Pass) $1,000.00
Couple Membership (Includes Range Pass) $1,490.00
Single Membership (Includes Range Pass) - Auto Pay $1,060.00
Couple Membership (Includes Range Pass) – Auto Pay $1,550.00
Child or Grandchild (High School and Under W/ Single or Couple) $75.00
Junior Membership (High School and Under) $150.00
College Membership $250.00
Annual Trail Fee $195.00
Cart Storage and Trail Fee (Members ONLY) 1 $425.00
Season Cart Pass2 $425.00
Men’s Golf Association $35.00
Sub-Total: $________
Tax 7.9%: $________
Grand Total: $________
PAYMENT OPTIONS (YOU MUST SELECT ONE)
o Payment in full at the time of application.
o Payment in 3 equal payments – due Feb 1, April 1 and June 1.
o Automatic Debit/Credit on the 15th of the month with the final payment December 15, 2010 with an additional fee of $5.00 per month.
___________________________ ______________
Signature Date
Ø Membership and Range fees are Subject to Sales Tax
Ø Visa and MasterCard Accepted
Ø All Memberships are Non-Transferable and Non-Refundable
Ø Any member who has not renewed their membership by March 1, 2011 will no longer be considered a member and will be charged green fees.
Ø An Administration fee of $30.00 will be added to all accounts not on the Automatic Debit/Credit that are not paid in full by June 1.
Ø Any member whose dues are not paid in full by June 1, 2011 will be required to pay green fees and membership privileges will be suspended until dues are paid in full. If dues are not paid by July 10, 2011 further action will be taken.
Ø All grill charges are required to be paid in full the month following to maintain charging privileges.
[1] TO MAINTAIN YOUR CART SHED – cart storage must be paid in full with a payment of at least 1/3 of your total membership fee by March 1, 2009.
2 Cart subject to availability and is not included in tournament entries or corporate events