Forest Park Country Club

“The Park”
PO Box 4106
Martinsville, VA 24115

Application for Membership
Membership is offered only by invitation of the current members.
I am being sponsored for membership by the following three(3) current members:
1.

____________________________________________

2.

____________________________________________

3.

____________________________________________

Name:

___________________________________________________________

Occupation: ___________________________________________________________
Place of Employment:

________________________________________________

Date of Birth: ________________

Social Security #: ______________________

Spouse’s Name:

_____________________________________________________

Occupation:

_____________________________________________________

Place of Employment:

________________________________________________

Date of Birth: ________________
Address:

Social Security #: ______________________

___________________________________________________________

Phone #(s): ___________________________________________________________
Children living at same address (include birth date(s)):
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

New Member
• Membership Dues - $100.00 per month
• Debt Reduction Assessment Fee - $20.00 month
• Tax Reduction Assessment Fee - $10.00 month

Total membership dues and assessments - $130.00 month

By signing this application I agree to abide by all the rules of Forest Park
Country Club and any future amendments, to pay my dues and
assessments and all charges on time each month along with any changes
to current dues and fees, and to maintain my membership by paying
monthly dues for a minimum of one year (unless you move out of the
area or the club closes). I further acknowledge that interest in the amount
of 0.5% per month will be charged on past due amounts, a credit check will
be made prior to my being considered for membership, and that dues and
assessment are subject to change. The undersigned Applicant(s) hereby
agree(s) that, in the event payment on this account is delinquent, the
Applicant(s) shall be responsible for payment of reasonable attorney’s fees
and court costs incurred by Forest Park Country Club as a result of said
default and collection thereof.
Applicant:

__________________________________________

Applicant:

__________________________________________ (spouse)

Date:

___________________________

How did you find out about this membership?
( ) Friend

( ) Advertisement

( ) Other ___________________________________

If by advertisement, where did you hear our advertisement?______________________
______________________________________________________________________

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