City Club at Lost Plantation

Couple W/Cart Plan Enrollment

Dues are $355.00 and this is a monthly membership. ** Pro-Rated dues to join today are $177.50 **

Purchaser

First Name

Last Name

Phone Number

Email Address

Confirm Email Address

Address

City

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Zip Code

Primary Member

First Name

Last Name

Birth Date

Gender

Phone Number

Email Address

Confirm Email Address

Address

City

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Select State

Zip Code

Sub Member

First Name

Last Name

Birth Date

Gender

Relationship

Email

Staff Member or Referring Members Name at City Club at Lost Plantation

Couple W/Cart Plan Terms & Conditions

All active membership accounts that are 60 days delinquent will be subject to suspension of membership and all playing privileges will be revoked until the account balance is settled.
With completion of this form, you are committing to an annual membership at City Club. All memberships will automatically renew on January 1 unless cancellation request is received in writing.

I have read, understand and accept the terms and conditions of the Couple W/Cart Plan.