I
hereby apply for membership in the
Initiation
Fee - $500.00 (The
initiation fee is waived at the present time)
Family
Membership - $1380.00 PER
YEAR includes all privileges for husband, spouse and single children under age
of 25 and living at home.
Co-Ed
& Corporate Membership - $1380.00 PER YEAR includes all privileges for the member and limited
privileges for significant other as outlined in the clubs rules and
regulations.
Single
Membership - $1035.00 PER
YEAR includes all privileges for applicant only.
Senior
Family Membership - $1135.00 PER
YEAR includes all privileges for husband and spouse, when one is 65 years of
age by December 31st 2008.
Senior
Single Membership - $920.00 PER
YEAR includes all privileges for applicant only who is 65 years of age by
December 31st 2008.
Super
Senior Single Membership - $805.00 PER YEAR includes all privileges for applicant only who is
75 years of age by December 31st 2008.
Super
Senior Family/ Super Senior Co-Ed Membership - $920.00 PER YEAR includes all
privileges for applicant family and Super Senior significant other as outlined
in the clubs rules and regulations, who is 75 years of age by December 31st
2008.
( ) Family
( ) Co-Ed ( )
Corporate ( ) Single
( ) Senior Family ( )
Senior Single
( ) Super Senior Single ( )
Super Senior Family/ Super Senior
Co-Ed
Annual Dues
$_____________ (This amount is
due when accepted into the club)
Applicant Name
_______________________________Spouse/Other____________________________
Home Address_______________________________________City______________________________
State
__________________ Zip Code
__________________
Home
Phone___________________ Cell___________________
Email_________________________________
1) _____________________ Age ____ 2)_____________________
Age____
3) _____________________ Age ____ 4)_____________________
Age____
5) _____________________ Age ____ 6) ____________________ Age ____
Employer Name ________________________________Occupation__________________________
Address_________________________City____________________ST________
Zip__________
Work Phone ___________________
Enclosed is my check for $__________________
Signed_______________________________
Member Sponsored By:
_________________________
Application Approved By ____________________
Date_____________________
Address:
Phone: 859-472-2150 Fax:
859-472-2555 PCC website: www.