Mercerwood Shore Club Membership Application

Name_________________________________________
Spouse_________________________________________
Home Address______________________________ City________________________
Zip________________________ Home Phone________________________
Place of Employment_________________________________________
Business Phone______________________
Email Address______________________
 
 
Children
Last NameFirst NameM/FBirthdate
_____________________________ _____________________________ _____ _____________________________
_____________________________ _____________________________ _____ _____________________________
_____________________________ _____________________________ _____ _____________________________
_____________________________ _____________________________ _____ _____________________________
_____________________________ _____________________________ _____ _____________________________
If my application is accepted by the Mercerwood Shore Club Board of Trustees, I agree:
  1. To adhere to the bylaws and policies of the Mercerwood Shore Club now adopted or hereafter instituted.
  2. To use the club facilities in an acceptable and responsible manner.
  3. To pay monthly dues and other charges by the 10th of the month in which the bill is received. A late fee of $5.00 will be added to any overdue account.
Date: ________________________
Signature: ________________________
Spouse's signature: ________________________

Were you referred by a current club member? If so, whom? ____________________________

Equity Membership: ____________ ($4800)

FOR OFFICE USE ONLY
Membership #__________           Wait list fee: $_________
Date joined__________           Joining fee: $_________
Member packet sent__________           Total owing: $_________