MEMBERSHIP APPLICATION

Long Branch Swim & Racquet Club

2011 Membership Form and Ballot

Name____________________________________________________________________________________

(Please print)

Address __________________________________________________________________________________

Phones: Home_____________ Other_____________E-mail (pool business only)_________________________

Emergency Contact(s):  _________________________________Phone (s):___________________________

Budget Referendum and Board Election

Members Only:  I approve the 2011 Proposed Budget (attached)    Yes_______               No_______

Members Only:  I approve the 2011 Board of Directors (attached)   Yes_______               No_______

Volunteering   

I and/or family members volunteer to help the pool with clean up and maintenance on one of the following dates.  (This year we are offering an "opt out" option to members who do not volunteer for one of our cleanup dates.  To "opt out" members are asked to pay a one-time $30 fee that will fund any cleanup that needs to be contracted or outsourced.):

April 16_____    April 24_____    May 1_____      May 15______ (time is 8-11 am)  Maintenance Fee ______

Membership Options and Fees (Special Discount for Payment by March 31!)

To become a new member or renew a membership in the Long Branch Swim & Racquet Club for the 2011 season, complete this form, circle your membership choices below, and mail this form and the attached volunteer form with your check to:

Long Branch Swim & Racquet Club

P.O. Box 2268

Springfield, VA 22152

CIRCLE THE OPTION NUMBER OF YOUR CHOICE:

            Option 1: Annual dues for family w/ permanent membership, or renters whose landlord has membership:

                                                                        Payment by March 31, 2011:                    $375.00

                                                                        Payment after March 31, 2011:                  $400.00

                                                                        Split Payment ($200 due 3/31 & 4/16)        $400.00

Option 2: Golden Dolphins annual dues for “empty-nest” members over the age of 50:

                                                                        Single rate:                                              $125.00           

                                                                        Couple rate:                                             $175.00

Option 3: New families / others who want to become permanent members but haven’t paid initiation fee:

                                                                        One-time Initiation Fee                              $200.00

                                                                        (Plus applicable dues payment under Option 1 or 2)

Option 4: Families who wish to join only for 2011 season without becoming permanent members:

                                                                        Payment in full:                                        $425.00

Please specify the family members entitled to pool admission under the membership option that you circled:

First Name                                Last Name                                Birth date*                          Comments/Medical Alert

*Please provide birth dates for children under the age of 18 years.

One-time Initiation Fee (if applicable)      $___________________

Annual dues amount from chart above:   $___________________

Book of 10 guest passes                                           $__25.00_____________

Maintenance Fee in lieu of volunteer clean-up hours:    $__30.00____________

Total enclosed                                      $___________________

(Pool use only: Check rec’d___/Membership logged____/Cards made___/Volunteer log____/Membership Chair___)