Member Application Name * First Name Last Name Title Mr. Mrs. Ms. Dr. Rev. Email * Phone * (###) ### #### Date of Birth MM DD YYYY Address Address 1 Address 2 City State/Province Zip/Postal Code Country Spouse Name (if applicable) First Name Last Name Dependents Please provide first name, gender, and birth dates for all dependents living at home under the age of 21. Membership Level Please select one. For more information, see link at bottom for Membership Options and Pricing. “Pine Forest” Family Membership (Includes Golf, Tennis, Swim & Social) “Pine Forest” Senior Membership (Includes Golf, Tennis, Swim & Social) “Pine Forest” Single Membership (Includes Golf, Swim & Social) “Links” Family Membership (Includes Golf, Swim & Social) “Links” Senior Membership (Includes Golf, Swim & Social) “Links” Single Membership (Includes Golf, Swim & Social) “Courtside” Family Membership (Includes Tennis, Swim & Social) “Courtside” Single Membership (Includes Tennis, Swim & Social) “The Club” Family Membership (Includes Swim & Social) “The Club” Single Membership (Includes Swim & Social) Auto Draft Information (See Terms and Conditions Below) * I do hereby authorize Pine Forest County Club, to automatically draft my debit/credit card for my monthly member statement charges. I understand that my account will be drafted for the full amount due on the 10th of each month, or the first business day after the 10th of the month, whichever is earlier. Yes No Today's Date MM DD YYYY Card Number Expiration Date Name on Account First Name Last Name Thank you! Membership Options and Pricing
