Club Membership Registration Form

Physical Address: *

Mailing Address:

Dependents

Employer Address: *

Membership information is below. Please choose the proper membership based on your needs.

***$100 Initiation fee will be assessed on first payment for Regular or Junior membership levels

Membership Type	Amount	Detail
Regular	$85/Monthly $1020/Annually	Unlimited green fees & Use of pool and clubhouse for all dependents living in the member’s household.
Junior (Individuals under the age of 30)	$50/Monthly $600/Annually	Unlimited green fees & Use of pool and clubhouse for all dependents living in the member’s household.
Cart Shed Fee	$15/Monthly $180/Annually	Access to store a single golf cart in a provided shed at the golf course.
Pool/Clubhouse	$300/Annually (prorated first year if joined after season)	Unlimited access to the pool and clubhouse for all dependent living in the member’s household.

Membership Type *

Regular Junior Cart Shed Pool/Clubhouse
Banking Information
Bank Name: *
Routing Number: *
Account Number: *
Name on Account (if different then applicant)
This completed application form, along with payment of the initiation fee should be returned to:

Village Creek Golf Club
P.O. Box 252
Newport, Arkansas 72112

If you have any questions, please contact Greg Cooper at (870) 217-1622
Legal Statement
Legal Statement

I hereby make application for membership in Village Creek Golf Club, Inc. of Newport, AR and agree, if elected, to comply with the by-laws, golf course rules, swimming rules, house rules and such special regulations for members as the Board of Directors may adopt.

I also hereby authorize Village Creek Golf Club to draft my account for payment of dues and other fees, provided there are sufficient collected funds in said account to pay the same upon presentation. This authority is to remain in effect until revoked in writing and I agree that if such check is dishonored, whether with or without cause and whether intentionally or inadvertently, the club will be under no liability whatsoever even though such dishonor may result in the forfeiture of membership.
Signature:
*

I have read, understood, and accepted the above statement.
Once you submit your application, we will contact you shortly to complete your membership application.

Thank you!
Signature *

Clear
DateTime
Should be Empty:

Now create your own JotForm - It's free! Create your own JotForm

Village Creek Golf Club Membership