GLASS HILL GOLF CLUB, INC.

P.O. BOX 28  DOVER RD.

BARNEVELD, NY  13304

glasshillgolf.com

2009 STATEMENT OF DUES

Application for Membership/Renewal

Date ___________

Name (s)  _______________________________________________________________

Address ________________________________________________________________

Telephone ___________________________ email ______________________________

PLEASE CHECK MEMBERSHIP THAT APPLIES:

_______ SINGLE DUES  $346.11 ($319.73 + $26.38 8.25%SALES TAX)

_______ COUPLE DUES  $477.38 ($441.00 + $36.38 8.25%SALES TAX)

_______ FAMILY DUES  $537.06 ($496.13 + $40.93 8.25%SALES TAX)

 A NEW applicant must submit a refundable $100.00 application fee and provide (2) two current member signatures as sponsors with this form to be placed on our waiting list.

Applicant _______________________________________

Sponsors _______________________________ ________________________________

Any current member wishing to upgrade his/her membership status in the following fashion; Single to Couple, Single to Family, or Couple to Family must sign this document and provide (2) two other current members signatures as sponsors of this application.

Applicant _______________________________________

Sponsors _______________________________ ________________________________

COUPLE & FAMILY MEMBERS MUST BE FROM SAME HOUSEHOLD AND/OR A DEPENDENT ON THE CORRESPONDIING MEMBERS INCOME TAX RETURNS.

PLEASE LIST ALL MEMBERS ELIGIBLE TO PLAY UNDER MEMBERSHIP:

NAME & AGE  (if child)

1. _________________________ 3._______________________ 5.___________________

2. _________________________ 4._______________________ 6.___________________

Trail Fee – fill in separate form ($135.00)

Please send completed document and full fee amounts by April 1 to above address.

GLASS HILL GOLF CLUB, INC.

P.O. BOX 28  DOVER RD.

BARNEVELD, NY  13304

glasshillgolf.com

Trail Fee Application

I hereby agree to proper use and procedure of carts on the course at Glass Hill.  I acknowledge the undersigned person(s) will be the only users (drivers) of said cart.  I have enclosed $135.00 for my trail fees in addition to my regular membership fees.

Please print names clearly on lines below:

1.__________________________________________

2.__________________________________________

Cart Number_____________________ 

Signed:_________________________________________

Date:___________________________________________