MEMBERSHIP APPLICATION

NAME: ___________________________________________________________________________

SPOUSE (if joining): _________________________________________________________________

ADDRESS: ________________________________________________________________________

CITY & ZIP: _______________________________________________________________________

HOME PHONE:___________________________ WORK/CELL PHONE:______________________

E-MAIL ADDRESS:__________________________@_____________________________________

SPONSOR (new members only/limit one name): _____________________________________________

CHILDREN'S NAMES DATE OF BIRTH GENDER

___________________________________________________________________________________________________________________________________

BABYSITTER'S NAME: _________________________________________________ AGE: ______________

____________________________________________________________________________________________________________________________________________________________________________________

DUES CALCULATION

*Membership Dues (rates include tax) $________________

*Babysitter pass (single rate - includes tax)

*dues must be paid in full by deadline to receive discount rate $________________

Umbrella rental ($90) $________________

__________ I would like to rent an umbrella.

I prefer location: ____________________

Rental fee must be accompanied by minimum membership payment of $100

Lounge Rental ($60 each) $________________

I would like __________ lounge(s).

Rental fee must be accompanied by minimum membership payment of $100

Total Due $___________________

____________________________________________________________________________________________________________________________________________________________________________________

METHOD OF PAYMENT

(please note: minimum down payment of $100 to reserve your membership plus any umbrella/lounge rentals)

My check for $_______________ is enclosed

Credit Card Payment:

_____ I authorize Leisure Time to charge $_______________ to my account.

_____ I authorize Leisure Time to charge my account in _____ (# of months) equal monthly payments on or about the 15th/30th day (choose one) of the month. I want my final payment processed by: End of Oct/ End of Feb. / End of April / Opening Day (choose one).

Discover/MasterCard/Visa: __________ __________ __________ __________ Exp. ________ / ________

Billing Address Zip Code: __________ 3 Digit Security Code: __________

Signature____________________________________________________ Date _________________

You may send payment by mail to:

Leisure Time, Inc.

4561 Darrow Rd.

Stow, OH 44224

Or join by telephone: (330) 688-4162 Or by FAX: (330) 688-4310

Memberships must be paid in full by Opening Day. Membership cards may be picked up at the office when paid in full. REFUND POLICY: All payments refunded (except a $40 processing fee) if you apply for refund before the golf course or pool open for the season. Pro-rata refund on a monthly basis after Opening Day with proof of re-location of primary residence.