Membership Application Form printable pdf download

HEART OF THE HILLS SWIM CLUB, INC.

P. O. BOX 80083

ROCHESTER, MI 48308-0083

MEMBERSHIP APPLICATION FORM

BOARD OF GOVERNORS:

The undersigned hereby makes application for membership in the Heart of the Hills Swim Club.

Attached is a $25.00 non-refundable deposit, which will be applied toward the initiation fee upon

admission into the Club.

As an applicant, I understand that I will be placed on a waiting list in the order that my application is

received and that membership changes are processed year-round. When a current member

terminates and a membership becomes available, it will be offered to the next person on the waiting

list. Should I choose not to join when invited, my name will be removed from the list.

The following information is submitted in support of this application and to indicate eligibility for

membership.

Applicant: _______________________________

Phone: ___________________________

Joint Applicant (spouse of Applicant): ______________________________________________

Residence Address: _____________________________________________________________

City: __________________________________

Zip Code: ________________________

E-mail address: ________________________________________________________________

Children: Name: _________

Birthdate: ______

Name: _________ Birthdate: ______

Name: _________

Birthdate: _______

Name: _________ Birthdate: ______

Name: _________

Birthdate: ______

Name: _________ Birthdate: ______

Name of any other adult family member living in the household (grandparents, adult children, etc.):

_____________ ________________________________ Relationship: ___________________

The undersigned agrees that, upon admission to membership, he/she will abide by all the rules,

regulations and by-laws of the Club.

Signature: ________________________________________

Date: _________________

Notes: a) Make all checks payable to HEART OF THE HILLS SWIM CLUB.

b) Upon admission to the Club, a Membership Bond must be purchased. Also, the balance of

the initiation fee is due. Upon termination of membership, the bond may be redeemed

subject to conditions stated in the by-laws.

c) If you have any questions, please feel free to contact the Business Manager, Barbara

Geiger, at (248) 805-1415. Check your waiting list number and club information at

FEES: (as of 03/06/2014 – subject to change)

Refundable:

Membership Bond $1350.00

Nonrefundable: Initiation Fee $425.00 Yearly Dues $630 (2014)

For office use only:

Date Received: _______________________

Invitation Sent: _______________________

_________Accepted or __________Declined

Check # __________ or Cash: ___________

Acceptance Date: _____________________

Date: _______________________________

Wait List # __________________________

Payment Due: ________________________

Member Number: ____________________

Membership Application Form

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