Membership Application Member Name(Required) First Last Date of Birth(Required) MM slash DD slash YYYY Spouse Name First Last Children Name(s) & Date of BirthOne per lineEmail Cell Phone(Required)Home PhoneWork PhoneHome Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Winter Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Membership Category and InterestsProperty Owner Member Yes No Are you a property owner in Park Lawn Beach Association and applying for membership as a Park Lawn Beach Property Owner?Junior MemberAre you between the ages of 18 and 34 Yes No Legacy ApplicantAre you currently between the ages of 18 and 25 and one of your parents is currently a member of ICC? Yes No Have you recently divorced the primary ICC Active member and wish to maintain your own ICC membership?Have you recently divorced the primary ICC Active member and wish to maintain your own ICC membership? Yes No Do you or your family have interest in any of the following activities and wish to be contacted by an ICC member to receive additional information (check all that apply):Do you or your family have interest in any of the following activities and wish to be contacted by an ICC member to receive additional information (check all that apply): Men's League Women's League Senior Scramble Lessons Youth Golf Tournaments Tennis Social Activities Clubhouse Rental Membership Agreement(Required) I agree to the membership agreementI hereby make an application for membership to Inverness Country Club, and if accepted, agree to conform to the provisions of the Bylaws of ICC, the Rules of Play and all other regulations passed by the Board of Directors. I understand the initiation fee ($1500 Full Membership, $500 Junior Membership) will be held as evidence of my good faith in seeking membership to ICC. I also understand that I may withdraw my application and initiation fee (non-interest accruing) at any time prior to being elected to membership. After the election to membership, the initiation fee cannot be redeemed or recovered upon termination of full membership. It is also understood that the current yearly dues and any current special assessments will be payable within 30 days of election to the membership or the next yearly billing cycle, at the discretion of the Board of Directors and according to payment options available at the time of elected membership. This application is executed by the undersigned with the express understanding that election to the membership is subject to approval by the Board of Directors of the Inverness Country Club. Please mail this Membership Application to ICC at the address listed above in the letterhead or simply drop it off at the Pro Shop. By submitting your name below, you agree to the terms and conditions above.Referred BySignature(Required)Any Additional Details?
