Experience Lochland Country Club

Authorization and Agreement The undersigned hereby confirms that the information provided in this application is true, complete and correct, and authorizes Lochland Country Club (the “Club”), through its representatives, to conduct any inquiry into the undersigned’s financial condition and professional background as it considers necessary and appropriate. The undersigned acknowledges and agrees that a membership requires a one year minimum commitment to pay monthly dues from the date listed below. This contract expires one year from the first billing date, assuming all obligations under this agreement have been paid in full. After this one year period, the undersigned’s membership will continue on a month to month basis at the current membership dues pricing unless written documentation for any membership changes is received. 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 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

FOR OFFICE USE ONLY

Date Accepted

Date Interviewed

Director of Membership

General Manager

www.LochlandCC.com (402) 462-4151 601 W. Lochland Road Hastings, NE 68901