Membership Application

* First name

* Last Name

* Address

* Home Phone #

* Cell Phone #

* Email Address

* Birth Date

* Employer

Occupation

* Employer Address

* Office Fax #

* Spouse's Name

Spouse Birth Date

* Spouse Cell Phone

* Spouse Email Address

Spouse Employer

Occupation

Spouse Employer Address

Office Phone #

* Dependent Children and Dates of Birth

* Have you ever been a LSYCC member?

Yes

No

* If yes, when and what category?

* Name(s) of Lake Shore sponsor(s) for this application

* Desired Membership Category (choose one - see dues structure below):

* Supplemental Membership Options (check if either is desired)

Family Golf Priveleges

Golf with Harbor Privileges

* Payment options

Equal monthly installments

Annual dues paid in full

Initiation fee is waived for 2009-2010 season.

Member’s Contractual Agreement

I understand and agree that as a member of Lake Shore Yacht & Country Club, I assume responsibility for the payment of initiation fees, full fiscal years dues, assessments, pool, harbor, clubhouse and pro shop charges, and food and beverage minimums and any other fees/charges as outlined in the Club Rules and Regulations and By-Laws and that my membership will continue on a yearly basis thereafter unless I notify the Board of Directors in writing thirty days prior to the start of any given membership year.

Lake Shore Yacht & Country Club is a member-owned equity club. Achievement of ownership and equity status requires approval by the Board of Directors plus payment of the Initiation Fee. After vesting, Lake Shore’s Equity Program allows a member in good standing to be refunded their initiation fee at the time of their resignation.

I further understand and agree that I am subject to the Rules and Regulations and By-Laws established by the membership and Board of Directors and that I accept all provisions, thereof, as part of the terms and conditions of this membership contract.

Lake Shore Yacht & Country Club may, at its sole discretion, allow for early termination of this membership agreement only for cases deemed by the Board of Directors as being due to relocation for employment or for serious medical conditions. I understand that any overdue balances on my account are subject to interest at the rate of 1-1/2% per month, 18% per annum and the collection of reasonable attorney’s fees and costs and disbursements associated with collection.

Per By-Laws, member account charges are due and payable by the end of the following month. I agree to provide Lake Shore Yacht& Country Club with a valid credit card number and authorize Lake Shore Yacht & Country Club to charge this card for all dues, fees, installments and charges that are 15 or more days in arrears . Members whose accounts are in arrears may be posted and denied all club privileges until charges are paid.

I further understand, that as a Member, a default by me in the payment of any monetary obligation or termination of my membership, shall result in acceleration of balances due including my initiation fee if the payment plan was chosen, as well as any other charges outstanding on my account, as determined by the Board of Directors in their sole and absolute discretion.

* Candidate's Name

* Date

* Credit Card Type

VISA

Master Card

American Express

Discover

* Credit Card Expiration Date

* Credit Card Security Code

2009 Dues Structure

Full Golf - $4,700 Add $100 for Family; add $100 for Harbor

Senior Golf - $3,350 Family option included; add $100 for Harbor

Bus Prof Woman - $2,900 Family option not offered; add $100 for Harbor

Clergy - $1,450 Add $100 for Family; add $100 for Harbor

Junior Golf -
      Age 21                $1,700
      Age 22                $1,800
      Age 23                $1,900

Age 24 $2,000

Age 25 $2,100

NOTE: Family Option included for 21-25 years; add $100 for Harbor

Age 26 $2,350
Age 27 $2,500

      Age 28               $2,700
      Age 29               $2,850
      Age 30               $3,000
      Age 31               $3,200
      Age 32               $3,450
      Age 33               $3,650
      Age 34               $3,800
      Age 35               $3,950

NOTE: Add $100 for Family Option for 26-35 years old; add $100 for Harbor

Harbor - $2,300 (plus additional dock fee based on size of boat)

Pool & Social - $1,050

Dining & Social - $400

NOTE:
- Social Security # will be required by the Business Office after application has been approved.
- All membership categories are subject to a food & beverage minimum of $75 per month.

- All dues, minimums and fees are subject to NYS sales tax.

* Indicates Response Required