membership application 2

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					                                                 James Creek Staff Use Only
                                                  Received By: __________
                                                  Date: _________________


                  James Creek Tennis Center
                      Membership Application

Applicants Name: ____________________________________________
Spouse’s Name (If Family Membership): __________________________
Address: ____________________________________________________
City: ________________________ State: ____ Zip: _________
Home Phone: ___________________ Cell: _______________________
E-mail Address: ______________________________________________
Interests: (circle) T2 K-Swiss USTA ALTA
Preferred times of play: Weekday ______ Weeknights _______
Applicants Rating: USTA: ______ ALTA: _____
Spouses Rating: USTA: _______ ALTA: ______

List other family members on membership.

1. __________________ Date of birth   _________ Relationship_________
2. __________________ Date of birth   _________ Relationship_________
3. __________________ Date of birth   _________ Relationship_________
4. __________________ Date of birth   _________ Relationship_________



Initiation Fee: (One time Fee)

     Family: _______ $400.00
     Individual: _____ $200.00
Membership Options: Membership rates are for 2010 only.

      Option 1: Yearly

       Family: _______ ($440.00)/Year
       Individual: _____ ($275.00)/Year

Form of Payment:
Cash: __________ Check: # ___________ Credit Card*: __________

*Members may pay dues by Visa/Mastercard. If you wish to pay dues by credit card,
please complete the following information:

Name (as shown on the card): _____________________________
Credit Card number: _____________________ Exp. date: _______
Signature:     ________________________ Date: ______________


      Option 2: Monthly**

       Family: _______ ($45.00)/month
       Individual: _______ ($28.00)/month

**Monthly membership dues must be paid by Credit Card. Please complete the following
information and sign Automatic Charge Agreement below:

Name (as shown on the card): _____________________________
Credit Card number: _____________________ Exp. date: _______
Signature:     ________________________ Date: ______________


              Monthly Membership and Automatic Charge Agreement

By providing my credit card number to James Creek Tennis Center, I understand that
charges will be billed to my credit card number in accordance with the James Creek
Tennis Membership Agreement. I authorize this automatic billing by James Creek
Tennis Center. In the event the charges are not paid by the issuer of my credit card for
any reason James Creek Tennis Center may resubmit the charge. If the resubmitted
amount is not paid, I agree that the rejected amount plus a $25.00 service charge will be
added to my next regularly scheduled charge. I also acknowledge that failure to pay
amounts due could result in a suspension or termination of my membership in James
Creek Tennis Center. I also understand that I may terminate the Monthly Dues
Membership at any time by giving James Creek Tennis Center a 30-day written notice.
After the receipt of the termination notice, I agree that I will be billed for one more
month. Any prepaid dues or dues processed prior to the effective date of cancellation are
non-refundable.

Signature: ___________________       Date: _______________
Membership Agreement:
In Completing this form, I understand and agree that:

All memberships are subject to approval by James Creek Tennis Center. Membership
does not confer or include any ownership, beneficial or vested interest in the facilities,
assets of James Creek Tennis Center, or activities. Membership is not transferable.
Initiation fees and dues are non-refundable and subject to change. Membership in James
Creek and use of the facilities are subject to policy and procedures formed by James
Creek Tennis Operators.

All exercise and participation is done at the risk of the Member and his/her guest. James
Creek Tennis Center is not liable for personal injury, theft, loss, or damage of personal
property.

I hereby acknowledge that I have read and understand the policy and procedures of James
Creek Tennis Center, and agree to bind by them as they exist now and as they may be
amended in the future.

______________________________Date:___________________________________
(Applicants Signature)

        For Parents/Guardians of Participants of Minority Age
             (Under Age 18 at the time of registration)

This is to certify that I, as parent/guardian with legal responsibility for all my children, do
consent and agree to release James Creek Tennis Center harmless of all liabilities in my
child’s participation in any and all programs at James Creek Tennis Center.

____________________________                ______________
Parent/Guardian Signature                   Date

Emergency Phone Number(s) : ___________________/___________

				
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posted:11/5/2012
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