Membership Application Form
January 1, 2010 to December 31, 2010
Name_______________________________________________________ Date of Birth ________________________
Name_______________________________________________________ Date of Birth ________________________
Name_______________________________________________________ Date of Birth ________________________
Name_______________________________________________________ Date of Birth ________________________
Mailing Address____________________________________________________________________________________
Town _________________________ State_______ Zip_____________ Phone Number ______________________
Email Address _____________________________________________________________________________________
Membership Annual Fee VT 6% Unit Quantity Total
Sales Tax CostCouple – Husband + Wife/Civil Union $ 1035.5
0 $ 62.13 $ 1,097.63 X ______ = ____________Single – Age 19 and up $ 599
.50 $ 37.97 $ 635.47 X ______ = ____________College – Full-Time Student (age 19-24) $ 272
.50 $ 16.35 $ 288.85 X ______ = ____________Junior – Under age 19 $ 98
.10 $ 5.89 $ 103.99 X ______ = ____________Dual Member – as described below* $ 359
.91 $ 21.59 $ 381.50 X ______ = ____________Other Services
GHIN Cards (Optional, but required $ 21
.80 $ 1.31 $ 23.11 X ______ = ____________for League and Tournament Play)
Locker Fees $ 32
.70 $ 1.96 $ 34.66 X ______ = ____________Member Owned Carts** $ 250
.70 $ 15.04 $ 265.74 X ______ = ____________*If you are a member of another VT golf course, you must submit along with payment,
Donation to Capitalproof of your 2010 membership from the course you have paid a full priced membership.
Improvement Fund: ____________**Each year, members must provide a certificate of insurance on personal carts and sign
an unconditional waiver of liability. Copies of waiver are available in the Pro Shop.
TotalPayment:
Check Enclosed: Make checks payable to Northfield Country Club, P.O. Box 306, Northfield VT 05663
Pay by Credit Card:
Card Number ____________________________________ Signature ___________________________________________
Expiration Date ___________________________________ Date _______________________________________________
Members in arrears after April 14th will not be given further notice. Anyone not paid will be required to pay Greens Fees which will not be credited toward membership fees. Installment payments may not be made. Please have your GHIN card activated on your first visit to the club.
By accepting a membership, each member acknowledges and assumes the risks and dangers incidental to golf, golf carts, including, without limitation, the risks of death, personal injury or property damage from lightning and other acts of God, errant golf balls and other objects thrown and hit, conditions of the Club’s property, including without limitation golf carts, and acts or omissions of Club managers and employees, other members, Club guests, and providers of services. By accepting a membership, each member agrees to release, waive his/her rights against, and discharge Northfield Country Club, its parents, affiliates, and subsidiary corporations, predecessors, successors, assigns, officers, directors, shareholders, agents, managers, employees, and independent contractors (collectively, the "Club") from any and all liability, responsibility or accountability, in damages or otherwise, for death, personal injury, or property damage which the member and the member’s guests have incurred or which may hereafter be incurred by the member and the member’s guests directly or indirectly from the acts or omissions of the Club. Each member agrees that this release of claims shall be binding on his heirs and legal representatives.
Please remember that hitting a ball while traffic is present, on holes adjacent to Rte. 12A,
may result in a two week suspension of membership privileges.
Northfield Country Club | P.O. Box 306, Northfield, Vermont 05663 | (802) 485-4515 |
www.northfieldcountryclub.com