Experience Licking Springs Country Club

If this application is accepted, and the applicant is admitted according to the Club’s formal admission procedures, the undersigned agrees to observe and be bound by the Bylaws and the Rules and Regulations of the Club then in effect, which may be updated from time to time. The undersigned acknowledges and agrees that a membership requires a one year minimum commitment to pay monthly dues and fees from the date listed below. The undersigned agrees to keep a current valid credit card on file with the Club at all times, and authorizes the Club to charge that card for any amounts owed to the Club, including amounts on monthly invoices, that are more than sixty days past due. The undersigned acknowledges and agrees that he or she is personally liable and responsible for all financial obligations relating to his or her membership, including any obligations related to use of the Club by his or her family members and guests.

Signature of Applicant

Date

Signature of Spouse/Significant Other

Date

Administrator Use Only

Applicant(s) Names

Date Approved

Date Disapproved

Initiation Fee Received

Monthly Dues

Minimums

Membership #

Other