RESIDENT MEMBERSHIP

Application of:………………………………… D.O.B………… S.S.#…………………

Address …………………………………………………. Phone (H) ……………………

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Sponsoring Member(s) …………………………………. E-Mail ………………………

I hereby make application for resident membership to the Pine Lake Trout Club.

I understand that resident membership includes the immediate members of my family, living at the same address, including children under the age of 21.  All others are considered guests and subject to the daily guest fee for fishing privileges.

1.      Mail the application with a check for $1000.00 (plus 6.5.0% sales tax) non-refundable, one time initiation fee. (Currently initation fee is being waived until June 30, 2012.)

2.      Membership card will be mailed within 10 days of receipt of your application.  Billing will be sent monthly for all subsequent charges.

3.      Monthly resident dues fee is $150 (plus 6.5% sales tax) per month.

4.      The Club requires a $50 (plus 6.5% sales tax) per month food minimum for dining.

5.      Change to the membership must be in writing to the Club 30 days prior to the effective date of change.

6.      ______.(initials) All charges are due monthly on receipt of statement.  Any delinquent account will be charged a 2% monthly finance charge.

7.      Failure to keep your account to date, will result in loss of privileges and possible suspension and/or cancellation.

8.      Signature of the application indicates agreement to abide by the club rules and regulations on the reverse side.

9.      Pine Lake Trout Club accepts American Express, Mastercard or Visa of payment of the initiation fee or settlement of your monthly account.

Liquor lockers are available for $6.00 per month.

            ___. Please reserve a locker

            ___. Not interested in a locker at this time.

Signed By __________________________.  Date _____________.

Accepted For Pine Lake _______________.  Date _____________.

A copy of this application and rules will be returned with your membership card.

Names and birth dates of

All members of the family …………………………………………………………………

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PINE LAKE TROUT CLUB

P.O. Box 23282, Chagrin Falls, Ohio 44023 (440) 543-1331

Web Site pinelaketroutclub.com

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Company or Firm             ………………………………………………………………

PINE LAKE TROUT CLUB

P.O. Box 23282, Chagrin Falls, Ohio 423 (440) 543-1331

Web Site pinelaketroutclub.com