Membership Application

Personal Information

I provide the following for the Club’s use in establishing my membership account at Fauquier Springs:

Name *

Home Address *

City *

State *

Zip *

Home Phone

Cell Phone

Date of Birth *

Employer or Business Name

Occupation & Title

Name of Spouse if Applicable

Home Phone

Cell Phone

Date of Birth

Employer or Business Name

Occupation & Title

Email Addresses for Club Correspondence *

Credit Card No. *

CVC Number *

Expiry Date *

Dependent Information:

Name

Date of Birth

Gender

Charging Privileges

Name

Date of Birth

Gender

Charging Privileges

Name

Date of Birth

Gender

Charging Privileges

Name

Date of Birth

Gender

Charging Privileges

Affiliations:

I am currently a member of the following clubs:

Name

City

Length of Membership

Fauquier Springs Member reference

Where did you hear about Fauquier Springs?

Membership Information:

Category:

I would prefer my monthly statements to be:

Were you referred to join the Fauquier Springs Country Club by a current member? *

Yes

If yes, which member referred you:

I understand

A) Payment of the account is due on receipt of the monthly statement. Applicant(s) agree jointly and separately to pay the account when due. Applicant(s) agrees that the Club may assess a late charge for past-due accounts as provided in the Rules and Regulations of the Club, as amended from time to time. Applicant(s) agrees to pay all reasonable attorney's fees and costs in the event that the member account is turned over to collections.

B) Applicant(s) and Corporate Designee (if applicable) agree to conform to and be bound by the Rules and Regulations of the Club, as they may be amended from time to time.

C) That this application will not be acted upon unless fully completed, signed and accompanied by payment for the full amount of the required fees. All decisions regarding membership shall be made without regard to race, color, sex, creed, religious affiliation or national origin.

D) Assuming my membership has been active for one full year, the undersigned understands he or she may resign his or her Membership in the Fauquier Springs Country Club at any time by providing written notice to the Club. If the undersigned resigns, such resignation shall become effective on the last day of the month following the month in which the written notice of resignation is provided to the Club. For example, if the undersigned should provide the Club with notice of its resignation on October 16, the undersigned's Membership shall officially terminate on November 30.

Applicant’s Signature

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Membership Application

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