I accept my invitation to membership and provide the ...



BUSINESS ( SOCIAL ( ATHLETIC

MEMBERSHIP NOMINATION

TWO RAVINIA DRIVE, SUITE 100

ATLANTA, GEORGIA 30346

MAIN LINE (770) 392-7300

FAX (770) 395-5191



CANDIDATE INFORMATION

Mr. Mrs. Ms. Miss Dr. Other      

Name       Date of Birth      /     /     

Home Address       City       State       Zip      

Home Phone       Cell       E-mail      

Marital Status: Single Married Widowed Wedding Anniversary Date      /     /     

Social Security #      -     -      Driver’s License #       State      

Company Name       Type of Business      

Title       Length of Employment       (years)

Bus. Address       City       State       Zip      

Bus. Phone       Fax       E-mail      

Administrative Assistant’s Name       Phone      

I prefer internet mail be sent to my Home Business

I prefer monthly statements be sent to my Home Business

SPOUSE INFORMATION

Mr. Mrs. Ms. Miss Dr. Other      

Spouse Name       Date of Birth      /     /     

Social Security #      -     -      Driver’s License #       State      

Company Name       Type of Business      

Title       Length of Employment       (years)

Bus. Address       City       State       Zip      

Bus. Phone       Fax       E-mail      

DEPENDENT INFORMATION

[A Dependent is an unmarried child under 21 (or under 23 attending college) residing with Candidate]

Name(s) Date of Birth Charge Privileges

           /     /      Son Daughter Yes No

           /     /      Son Daughter Yes No

           /     /      Son Daughter Yes No

           /     /      Son Daughter Yes No

REFERENCES

Our Member sponsor is       Phone      

Co-sponsor (if applicable)       Phone      

Other personal references (can be non-Member)

1.       E-mail/ Phone      

2.       E-mail/ Phone      

3.       E-mail/ Phone      

Civic/Professional Organizations:      

MEMBERSHIP INFORMATION

I/We am/are applying for Membership in the following category Full Privilege Single Full Privilege Family Social

Full Privilege Junior Single Full Privilege Junior Family

Initiation Fee $       Current Category Monthly Dues $      

I/We understand no portion of the Initiation Fee is refundable and that this is a nontransferable membership.

[Please Check One] Atlanta society Current Dues $      

YES, I/we accept the benefits of the Atlanta Society and elect to enroll in the Atlanta Society. I/We understand by joining at this time, the current society fee of $500.00 has been waived. I/We further understand that I/we will be subject to payment of monthly dues, which may be increased from time to time. I/We also agree to pay any charges I/we incur at the participating clubs upon receipt of my/our monthly statement. I/We further agree to conform to and be bound by the Bylaws and Rules and Regulations of the participating clubs as well as the terms and conditions pertaining to the Atlanta Society, all of which may be amended or modified from time to time.

NO, I/we decline membership in the Atlanta Society at this time. Should I/we decide to elect to participate in the Atlanta Society benefits in the future, I/we will be required to pay an upgrade fee which is currently $500.00 and subject to future increase.

[Please Check One] Associate Gold

YES, please enroll me/us in the Associate Gold Benefits selected below. I/We have reviewed the terms and conditions of the benefit, and I/we agree to those terms and conditions. I/We understand that because I/we am/are choosing to enroll in the Associate Gold benefits at this time, the current upgrade fee(s) for the Associate Club Benefits selected below have been waived. I/We understand that I/we will be subject to payment of additional monthly dues in exchange for the Associate Club Benefits which may be increased from time to time. I/We also agree to pay any charges I/we incur at the participating clubs upon receipt of my/our monthly statement. I/We further agree to conform to and be bound by the Bylaws and Rules and Regulations of the participating clubs, all of which may be amended or modified from time to time.

Signature Gold Golf       Current Upgrade Fee $       Current Dues $ 35.00

[insert name]

Signature Gold Dining       Current Upgrade Fee $       Current Dues $ 35.00

[insert name]

Signature Gold Unlimited       Current Upgrade Fee $       Current Dues $ 50.00

[insert name]

Associate Plus       Current Upgrade Fee $       Current Dues $ 10.00

[insert name]

NO, I/we am/are not interested in participating in upgraded Associate Club Benefits at this time. I/We understand that if I/we decide to participate in any available upgraded Associate Club Benefits in the future, I/we will be required to pay the then current upgrade fee which is nonrefundable and subject to future increases.

PAYMENT OF MEMBERSHIP ACCOUNT

Payment of Membership Account, including all dues, fees and other applicable charges, is due upon receipt of the monthly statement. If accepted for membership, Candidate agrees to pay the account in full when due. Candidate agrees and understands that a late charge may be assessed for past due accounts as provided for in the Rules and Regulations of the Club, as amended from time to time. In addition to late fees, penalties may include, but are not limited to suspension of Club privileges and/or expulsion from membership.

Candidate further agrees to maintain a major credit card account in Candidate’s name on file with the Club at all times. By signing below, Candidate agrees to and fully authorizes the Club to charge all such charges to credit card account(s) as stipulated below.

In the event that Candidate’s account becomes more than thirty (30) days past due, Club shall have the right to bill such past due amount to Candidate’s credit card. Payments on delinquent accounts apply first to reduce late charges and accrued dues, then to food and beverage charges, then to any other charges. Any fees assessed for untimely payment of any applicable dues, fees or charges will appear on Candidate’s statement, including any charges made to Candidate’s credit card for payment of same. Candidate agrees to pay all reasonable attorneys’ fees, investigator fees, and costs in the event this account is turned over for collection.

I hereby authorize the use of my Credit Card to pay the one-time initiation fee in the amount of $      .00.

I hereby authorize the use of my Credit Card to pay all dues and charges incurred at the Ravinia Club or Associate Clubs automatically on or around the eleventh (11) day of each month. I also understand if this card becomes invalid or is declined for any reason, I will be responsible for any late charges accrued on my account.

I do not wish to set up automatic use of my Credit Card. I hereby authorize my Credit Card to be on file.

VISA MASTERCARD AMERICAN EXPRESS

                 /     

Cardholder’s Name Card Number Exp. Date

MEMBERSHIP POLICIES

If accepted into membership, I/we agree to conform to and be bound by the enrollment terms contained herein, the Rules and Regulations and written membership policies of the Club (“Membership Documents”) as they may be amended from time to time. I/We further understand that agreeing to be bound by the Membership Documents is a part of my/our agreement for membership privileges with the Club. I/We specifically understand this membership is not divisible. I/We hereby acknowledge receipt of a copy of the Rules and Regulations of the Club.

I/WE ACKNOWLEDGE THE MEMBERSHIP RULES AND REGULATIONS PROVIDE THE DETAILS OF THE CLUB’S MEMBERSHIP POLICIES, CONDUCT AND OBLIGATIONS, INCLUDING, BUT NOT LIMITED TO, CONDUCT, FINANCIAL OBLIGATIONS, DISCIPLINARY ACTION, AND RELEASE OF LIABILITY FOR PERSONAL INJURY AND THEFT. I/WE ACKNOWLEDGE THAT IN THE EVENT I/WE WISH TO TERMINATE THE MEMBERSHIP THE CLUB REQUIRES A THIRTY (30) DAY WRITTEN NOTICE TO THE MEMBER RELATIONS DIRECTOR OR MEMBERSHIP DIRECTOR.

I AUTHORIZE THE RAVINIA CLUB TO CHECK MY CREDIT, EMPLOYMENT INFORMATION AND REFERENCES AND TO OBTAIN SUCH INFORMATION AS THE RAVINIA CLUB DEEMS NECESSARY TO EXTEND CREDIT TO ME UNDER MY MEMBERSHIP ACCOUNT.

I/We agree the terms and conditions of my/our membership may not be added to, amended, or contradicted in any way by evidence of prior, contemporaneous, or subsequent oral agreements of any kind and acknowledge there are no unwritten oral agreements of any kind.

Candidate’s Signature Date

FOR CLUB USE ONLY

Accepted On: By: Title:

Copy of this contract returned to Candidate on By:

Chrono Number: Activity Code: Member Number Type Code:

Initiation Deposit $ Date Received:

Initiation Deposit $ Date Received:

Initiation Deposit $ Date Received:

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