TPC PRESTANCIA MEMBERSHIP APPLICATION
CANDIDATE INFORMATION
❑ Mr. ❑ Mrs. ❑ Ms. ❑ Dr.
Primary Candidate__________________________________________________________________________________
Preferred Name Jr. Sr. Other Date of Birth / /
Home Address
City State Zip Sarasota Address City State Zip Home Phone Cell Phone GHIN
Marital Status Single Married Wedding Anniversary Date / / Driver’s License # State
Business Name Type of Business
Title Length of Employment ______ (yrs) Business Address City State Zip Business Phone Billing Email Address: _ Please send club correspondence emails to this primary email address
Spouse/Spousal Equivalent/Significant Other ❑ Mr. ❑ Mrs. ❑ Ms. ❑ Dr.
Preferred Name Jr. Sr. Other Date of Birth / / Driver’s License # State
Business Name Type of Business
Title Length of Employment ______ (yrs)
Business Address City State Zip
Business Phone Cell Phone GHIN
Please send emails to this address
DEPENDENTS are unmarried children under 25 residing with Candidate(s). _____ Yes I/we have dependents as indicated below. _____ No I/we do not have dependents residing with us. Name(s) Date of Birth Charge Privileges
/ / Son Daughter Yes No / / Son Daughter Yes No / / Son Daughter Yes No
REFERENCES
Our Member Sponsor is: Phone
Personal References (can be non-Member):
Name __________________________ Phone _____________________ Relationship
Name Phone _____________________ Relationship
MEMBERSHIP INFORMATION
I/We am/are applying for Membership in the following category:
Initiation Fee *: $ Monthly Dues** $ I/We understand no portion of the Initiation Fee is refundable and this membership is nontransferable.
* The “Initiation Fee” amount written above is the actual amount paid by Member (or if paying in installments, the amount required to be paid by Member) in United States dollars. The amount written above may be less than the Club’s current standard required initiation fee if certificates, waivers, or other special programs have been applied to this membership. Refer to attached promissory note or addendum dated for additional payments or conditions applicable to this Membership. **Applicable sales tax, if any, not included.
TPC Prestancia Membership Categories (circle)
Corporate Charter Traditional Young Professional Social ** Prepaid Dues are nonrefundable
HERITAGE PLUS NETWORK [Please initial YES or NO]
YES, please enroll me/us in the Heritage Plus Benefit selected below. I/We have reviewed the terms and conditions of the benefits, and I/we agree to those terms and conditions. I/We understand that because I/we am/are choosing to enroll in the Heritage Plus program at this time, the current upgrade fee below has been waived. I/We understand that I/we will be subject to payment of additional annual upgrade dues in exchange for the Heritage Plus program, which may be increased from time to time. I/We also agree to pay any charges I/we incur at the participating clubs directly to that participating club at time of visit. I/We further agree to conform to and be bound by the Membership Bylaws and Rules and Regulations of the participating clubs, all of which may be amended or modified from time totime.
Current Upgrade Fee $ 1,000 Current Annual Dues $ 480 (note: annual dues are pro-rated quarterly for new enrollments)
NO, I/we am/are not interested in participating in upgraded Heritage Plus benefits at this time. I/We understand that if I/we decide to participate in any available upgraded Heritage Plus benefits in the future, I/we will be required to pay the then current upgrade fee which is nonrefundable and subject to future increases. Membership currently provides no travel benefits within the Heritage network. Golf Fees – Initial * required for primary Locker/Bag Storage* $360 Name for Engraving d 2nd Bag Storage $180
A
PAYMENT OF MEMBERSHIP ACCOUNT
I/We would prefer membership account statements to be mailed to: Home Candidate’s Business Payment of Membership Account, including all dues, fees, and other applicable charges, is due upon receipt of the membership account statement. If accepted for membership, I/we agree to pay the account in full when due. I/We agree and understand that a late charge up to the maximum amount allowable by law, or other penalties, may be assessed for past-due accounts as provided for in the Membership Bylaws and Rules and Regulations of the Club, as amended from time to time. In addition to late fees, penalties may include, but are not limited to suspension of Club privileges and/or expulsion from membership. Payments on delinquent accounts shall be applied first to reduce late charges, then to reduce accrued dues and food & beverage charges (with the payment applied to reduce the oldest past due balances first), and then to any other charges. Any fees assessed for untimely payment of any applicable dues, fees, or other charges will appear on my/our statement. I/We agree to pay all reasonable attorneys' fees, investigator fees, and costs in the event this account is turned over for collection.
CONVICTED OF
[Please check YES or NO and INITIAL] _____ Yes _____ No
[Please check YES or NO and
_____ Yes _____ No _____INITIALS.
________ 2nd Locker $180 __________ 2nd Name for Engraving ___________________ HAVE YOU EVER BEEN
A SEXUAL OFFENSE OR REQUIRED TO REGISTER AS
SEXUAL OFFENDER? Primary Candidate:
INITIALS Spouse/Equiv/Other:
INITIAL]
MEMBERSHIP POLICIES
If accepted into membership, I/we agree to conform to and be bound by the enrollment terms contained herein, the Membership Bylaws, the Rules and Regulations, and written membership policies of the Club (“Membership Documents”) as they may be amended from time to time. I/We further understand that agreeing to be bound by the Membership Documents is a part of my/our agreement for membership privileges with the Club. I/We specifically understand this membership is not divisible. I/We hereby acknowledge receipt of a copy of the Membership Bylaws and the Rules and Regulations of the Club.
I/We understand that I/we may voluntarily resign from the Club as set forth in the Club’s Membership Bylaws. All accrued dues and other charges remain my/our responsibility and such resignation will not be final until full payment of same is received
I/WE ACKNOWLEDGE THE MEMBERSHIP BYLAWS AND THE RULES AND REGULATIONS PROVIDE THE DETAILS OF THE CLUB’S MEMBERSHIP POLICIES, CONDUCT AND OBLIGATIONS, INCLUDING, BUT NOT LIMITED TO, PROVISIONS IN THE EVENT OF DIVORCE, FOR ARBITRATION OF DISPUTES, RESIGNATION, REDEMPTION OF MEMBERSHIPS, FINANCIAL OBLIGATIONS, DISCIPLINARY ACTION, RELEASE OF LIABILITY FOR PERSONAL INJURY AND THEFT. I/WE HEREBY FULLY RELEASE AND DISCHARGE THE CLUB, ITS EMPLOYEES, AGENTS, SHAREHOLDERS, MEMBERS, MANAGERS, AFFILIATES AND ASSIGNS FROM ANY LIABILITY, INJURY, LOSS, DAMAGE OR CLAIM ARISING FROM MY/OUR USE OF THE CLUB FACILITIES.
By providing the address(es) (including e-mail), and phone numbers(s), above, I/we hereby give the Club my/our express written permission to contact me/us at each number or address in accordance with the terms and conditions of the Club’s Privacy Policy. I/We acknowledge that the Club values my/our right to privacy. I/We understand that I/we can revoke this consent at any time by contacting the Club in writing.
PHOTO RELEASE FORM I hereby grant non-revocable permission to TPC Prestancia to use photographs and/or video of me (and/or my family) taken at club events or on the course in club publications, news releases, online, and in other communications. I acknowledge that TPC Prestancia will own such images and further grant TPC Prestancia permission to copyright, display, publish, distribute, use, modify, print and reprint such images in any manner whatsoever related to their business.
________________________ (Signature of Adult, or Guardian of Children under age 18)
OR OPT OUT: I do not grant permission to TPC Prestancia to use my image in any way. If there is photography taken during a club event, it is my responsibility to take direct action to make the photographer aware that I/we decline to be in photos.
_________________________________________________(Signature of Adult, or Guardian of Children under age 18)
I/We agree the terms and conditions of my/our membership may not be added to, amended, or contradicted in any way by evidence of prior, contemporaneous, or subsequent oral agreements of any kind and acknowledge there are no unwritten oral agreements of any kind.
By signing below, we hereby certify that we hold a marriage license, or a certificate of domestic partnership or civil union, which evidences our existing spousal relationship. If we do not hold one of the above, we acknowledge that the Club requires execution of a separate Spousal Relationship Statement.
Primary Candidate’s Signature Date
Spouse/Spousal Equivalent/Spousal Designee Signature Date
Previous or Current Other Clubs:
Name of Club ______________________________________________________Length of Membership
City State Zip
Name of Club ______________________________________________________Length of Membership
City State Zip
Name of Club ______________________________________________________Length of Membership
City State Zip
Name of Club ______________________________________________________Length of Membership City State Zip
AUTHORIZATION AGREEMENT FOR RECURRING DIRECT DEBITS AND CREDITS MADE BY AUTOMATED CLEARING HOUSE (“ACH”)
I/We hereby authorize the Club to initiate credit and/or debit entries to my/our depository account at the financial institution named below, hereinafter called the “Depository.” I/We acknowledge that the origination of ACH transactions to my/our account must comply with the provisions of U.S. law, and that such transactions will be used to settle my/our monthly billing statements in full as they become due, which will vary in amount and will consist of (a) monthly membershipdues, (b) usage charges andfeesfor goods and services utilized or consumed at the Club or at participating reciprocal clubs, (c) additional fees, dues or charges for any upgrade benefits in which I/we have chosen to participate, (d) installments payable towards my/our Club Initiation Payment, if I/we elected to finance such Initiation Payment, (e) late fees and charges payable in accordance with the Club’s Rules and Regulations and billing policies, and (f) and other fees or charges which would commonly be billed to my/our membership account based on my/our authorization or usage (collectively, “Club Payments”). Not all financial institutions participate in ACH transactions; if my/our Depository does not participate, I/we will not be eligible for this service.
This authorization will remain in full force and effect until the Club has received fourteen (14) days’ written notification from me/us of its termination. Unless terminated in accordance with the terms herein, this authorization will automatically renew and extend to the payment obligations for each subsequent month and/or year, regardless of any customary dues increases or changes in membership category or classification.
I/We understand if any amounts are rejected by the Depository, I/we may be subject to any penalties or late charges imposed by the Club. I/We acknowledge that the Club reserves the right to discontinue ACH service at any time.
I/We represent that I/we have the authority to authorize the transactions contemplated by this authorization. I/We hereby authorize the Club to debit my/our recurring Club Payments from the Depository and account indicated below.
Branch City
Zip Routing No. Account No. (9 digit number at bottom left of check/deposit slip) (number to right of routing number)
of account (circle one): Checking Account Savings Account
voided check must be returned with this signed form.
account will be drafted on the
of each month.
date
the draft
business
Depository Name
State
Type
A
Your
20th
If such
occurs on a weekend or recognized holiday,
will occur on the following
day.
Print)
Name: Member Number: (Please
(If Joint Account)
Signature: Date: Signature: Date:
