Carroll Country Club

Date_____/_____/_____

Name______Member Birth Date_____/_____/_____

Spouse’s Name______Spouse Birth Date_____/_____/_____

Children’s Names______

Address ______

City______State______Zip______

Primary Phone Number______Secondary Phone Number______

Primary Email Address______

Secondary Email Address______

  • Will you accept monthly billing statements via primary email? ______yes ______no
  • Will you accept monthly newsletter via email? ______yes ______no
  • Will you accept weekly reminders via email? ______yes ______no
  • Will you accept text message reminders? ______yes ______no

If yes, what phone number (s) ______

  1. Stock Fee:

_____$100 for Golf Members only (optional under the age of 36)

  1. Type of Membership Applying for:Cost for Year/MonthCost for Year/Month
  • Full Membership (70 & older):______Single $1748/$146______Family $1748/$146
  • Full Membership (36-70): ______Single $1924/$160______Family$2368/$197
  • Full Membership (30-35):______Single $1556/$130______Family$1786/$149
  • Full Membership (under 30):______Single $1211/$101 ______Family$1443/$120
  • Non-resident Membership (20+ miles):______Single $1324/$110______Family$1324/$110
  • Social Membership:______Single $300/$25______Family $525/$44
  • Junior Membership:______$260 (summer only for 22 years old or less)

Please bill Golf/Social dues:______Monthly______Annually

  1. Club Improvement Fund:

_____$10 per month for Golf Members

_____$5 per month for Social Members

Please bill Club Improvement Fund Charge:______Monthly______Annually

  1. Food Minimum:

_____$30 per month for Family Members

_____$20 per month for Single Members

_____Pay food minimum annually and spend it quarterly ($360 for families and $240 for singles)

(No requirement for non-residents members, members 75 and over, and students)

  1. Services:

______Cart Storage______Range Membership ______Locker Rental

______Cart Lease ______USGA Handicap______Bag Storage

(Identify if husband and wife want service. Charges vary for each service.)

  1. Auto Gratuity: If you would like a gratuity added to your dining and bar tickets automatically, please indicate which percentage you prefer (10, 15, 17, 18, or 20%) ______%
  1. Auto Debit: If you would like your monthly statement of charges automatically withdrawn from checking or savings account fill out the following and include a voided check or deposit slip.
  • Bank Name______
  • Address______City______State______
  • Routing/ABA No.______CHECKING or SAVINGS
  • Account Number______

Signature______Print Name ______Date ______

Member Sponsor (if applicable) ______