Membership Application

We are pleased to consider your application. Please complete each section and have your sponsoring member sign below.

Applicant

Full name

Occupation

Telephone

Residence address

Membership category

ResidentFull clubhouse, dining, and grounds privileges$4,200 / yr

SocialDining and social events; no athletic facilities$1,800 / yr

SportsTennis, pool, and fitness; limited dining$2,600 / yr

Junior (under 35)Full privileges at the reduced junior rate$2,100 / yr

Sponsorship

Proposed by — sponsoring member

Seconded by

Dues

One-time initiation fee

Annual dues (category selected)

Total due on acceptance

Payment

Name on card

Card number — provided securely

•••• •••• •••• •••• Taken by the membership office — please do not write it here

Card type

Last 4

Expires

Billed securely upon acceptance — your full card number & CVV are never stored on this form.

Agreement

I hereby apply for membership in The Brierwood Club. If elected, I agree to abide by the Club's bylaws, house rules, and dress code, to pay my dues and house charges when due, and to conduct myself in a manner befitting the standards of the Club. I understand membership is subject to the approval of the Membership Committee.

I have read and agree to the Club bylaws and house rules.

Applicant signature

Date

Sponsoring member signature

Sponsor printed name