TEMPORARY MEMBERSHIP APPLICATION

Temporary Membership Application

THE APPLICATION AND PHOTOS MUST BE RECEIVED 48 HOURS IN ADVANCE OF YOUR ARRIVAL DATE. IF NOT SUBMITTED 48 HOURS IN ADVANCE, A $50 EXPEDITED PROCESSING FEE WILL APPLY. *PLEASE NOTE ALL TEMPORARY MEMBERSHIPS MUST COMPLETE A CREDIT CARD AUTHORIZATION FORM TO KEEP A CARD ON FILE FOR MEMBER CHARGE.
Applicant #1*

First NameLast Name
Applicant #2

First NameLast Name
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number*
Please enter a valid phone number.
Email Address- This is where the confirmation email will be sent.*
example@example.com
Dependents of the Applicant (children between the ages of 4 and 23):

Children under 4 years of age are not required to have a badge, please do not list them on the application.
Child #1
Date of Birth

MonthDayYear
Date
Child #2
Date of Birth

MonthDayYear
Date
Child #3
Date of Birth

MonthDayYear
Date
Child #4
Date of Birth

MonthDayYear
Date
Child #5
Date of Birth

MonthDayYear
Date
Child #6
Date of Birth

MonthDayYear
Date
Special Family Members

Additional adults over the age of 23 staying with you can be added for $60 per adult, per week.
Name of Special Family Member #1: (additional fee $60.00 per additional adult)
This fee is a per adult, per week fee.
Name of Special Family Member #2: (additional fee $60.00 per additional adult)
This fee is a per adult, per week fee.
Name of Special Family Member #3: (additional fee $60.00 per additional adult)
This fee is a per adult, per week fee.
Name of Special Family Member #4: (additional fee $60.00 per additional adult)
This fee is a per adult, per week fee.
Where are you renting?

Rental Home must be located in Lake Naomi or Timber Trails.
Owner of home Temporary Member will be occupying*
Location of home (Street Address) MUST BE LOCATED IN LAKE NAOMI OR TIMBER TRAILS. *
YOU MUST BE STAYING ONE WEEK OR LONGER TO BE ELIGIBLE FOR THE TEMPORARY MEMBERSHIP.

A LEASE OR CONFIRMATION FROM AN ONLINE BOOKING SITE IS REQUIRED TO VERIFY THE DATES OF YOUR STAY.
Check in date-Only Saturday options are available to be picked on the calendar for check in and check out. Temporary Memberships only run from Saturday to Saturday*

MonthDayYear
Date
Check out date*

MonthDayYear
Date
Date Guest will be notified

MonthDayYear
Date
Comments:
Is there something you need to tell us?
How did you book your property?*

Century 21Lake Naomi Real EstateVRBOAIR BnBOther
IF OTHER PLEASE EXPLAIN BELOW:
PLEASE ATTACH A COPY OF A LEASE OR CONFIRMATION FROM AN ONLINE BOOKING SITE. (confirmation MUST show a stay of one week or longer to qualify for the Temporary Membership). You may add photos here also, but please do not send photos in pdf format.

Cancelof
Lease/Online Booking Confirmation*

I have uploaded a copy of my lease or confirmation from an online booking site.I will email a copy of my lease or confirmation from an online booking site to afuller@lakenaomiclub.com before my check in date.
Photos*

Use my photos on file from a previous stayI will upload photos at a later date. I understand that if my photos are not received within 48 hours of my check in date, a $50 expedited processing fee will apply.
How would you like to access your badges?*

I will utilize the LNC Mobile App to access my membership badges. (Once application is processed, you will receive a confirmation email with log in credentials)I would like the physical membership badges printed for pick up at the Administrative Office (122 Route 423 Pocono Pines, PA, Open Mon - Sat 9AM - 4:45PM)
I understand that it is a REQUIREMENT to complete a credit card authorization form and put a card on file for member charge.*

I understand
TEMPORARY MEMBERSHIP PAYMENT
LIABILITY NOTICE: As in most recreation settings, there are inherent risks in the use of the facilities and grounds at Lake Naomi and Timber Trails. Thus there is a risk that you assume when you are involved in the use of any facility or on the grounds of Lake Naomi or Timber Trails. Caution and great care must be taken at all times by you, your family, and your guests in order to avoid injury. The Lake Naomi Club, the Timber Trails Community Association and the Pocono Pines Community Association, their officers and directors, their divisions, and their agents have no liability for lakes, pools, and grounds safety or for any injury occasioned by your use of the facilities and grounds of Lake Naomi and Timber Trails or by the activities of other members, guests, or others, regardless of whether their presence is authorized or unauthorized. In addition, the Club does not carry any form of accident/illness/death or dismemberment insurance on any Club Member or guest. Club Members and guests must rely on their individual health and accident insurance policies in the event they are injured at Lake Naomi-Timber Trails. TEMPORARY MEMBERSHIP GUIDELINES The Lake Naomi Club welcomes you as a Temporary Member of our Club. We want you to enjoy our beautiful amenities and have an outstanding and memorable experience. One thing that makes our Club exceptional is the harmonious relationship among our Members - both Regular Members and Temporary Members. To help you understand how that works, the Club requires the agreement below to be acknowledged by the Temporary Member, which makes clear the obligations of temporary memberships. We believe you will agree that the guidelines it defines are reasonable and will not restrict your enjoyment of your Club membership. No temporary membership shall be issued by the Club unless the prospective Temporary Member provides the Club with an agreement, signed by both the Temporary Member and by the Regular Member who is the basis for the temporary membership, containing the following provisions: 1. Temporary Member acknowledges that he/she has been informed of the Lake Naomi Club by-law provision, no person who is registered or is required to be registered for life in a)Pennsylvania's Statewide Registry of sexual offenders pursuant to 42 Pa.C.S.set section 9799.10 et seq., as amended from time to time, or b)the sex offender registry of any other state of the United States under a corresponding statute shall become, or continue to be, or have any of the rights of, a Member or guest, or otherwise use or be present at the Club Facilities. Termination of Membership shall be automatic and immediate for such offenders and the notice and review provisions of Article IV, Section 5 shall be inapplicable. 2. Temporary Member acknowledges that, in addition to any rental fees paid to Regular Member or Regular Member's agent, he/she is obligated to pay to the Lake Naomi Club a temporary membership fee that is based on the length of the temporary membership, plus any additional fees required for use of any of the amenities. 3. Temporary Member is responsible for any damage to any Club facility caused by Temporary Member and/or his/her family members or guests. 4. The Regular Member has provided to Temporary Member, and Temporary Member has read and understood, the Rules and Regulations relating to temporary membership and to the use of Club amenities. Without limiting the foregoing, Temporary Member understands and agrees that: - At no time may the premises occupied by Temporary Member have more than 12 people residing, as LNC Bylaw's limit usage to a single family. - Temporary Member shall not cause or permit any excessive noise at any time and, more specifically, Temporary Member shall not cause or permit any noise that intrudes on or is audible on any neighboring property before 8 AM or after 11 PM. - Temporary Member, Temporary Member's family members and guests shall not engage in any rude, disruptive, dangerous or unruly behavior. 5. Temporary Member and Regular Member are each responsible for any violation of the Rules and Regulations by Temporary Member, Temporary Member's family members and Temporary Member's guests. 6. Temporary Member and Regular Member agree that any first violation of the Rules and Regulations by Temporary Member, Temporary Member's family members or guests shall result in written notice to both Temporary Member and Regular Member, and that for any second or further violation, the Club may, at the sole discretion of its management, revoke the temporary membership and all rights and privileges associated with it, with forfeiture of all fees paid. 7. Regular Member agrees that Regular Member must either appoint a local agent or be personally available to respond within 8 hours of oral notice from the Club to assure and enforce Temporary Member's obligations and responsibilities to the Club under this agreement. 8. Temporary Member understands and acknowledges that the Club is not responsible for administering any lease agreement between Regular Member and Temporary Member, or for the condition, repair or maintenance of the leased premises. 9. Temporary Member understands and agrees that all Club Staff and other Members must be treated with courtesy and respect.
By signing below, I agree that I have read and agree to abide by the Terms & Conditions listed above.
Signature

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OFF SEASON RATES *SEPTEMBER 5- DECEMBER 22

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

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