City Club at Lost Plantation

Senior W/Personal Cart Enrollment

Dues are $165.00 and this is a monthly membership. ** Pro-Rated dues to join today are $90.48 **

Purchaser

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Last Name

Phone Number

Email Address

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Address

City

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Primary Member

First Name

Last Name

Birth Date

Gender

Phone Number

Email Address

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Address

City

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Zip Code

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

Senior W/Personal Cart 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 Senior W/Personal Cart.