Membership Application 2021

Innisbrook Resort Membership Application
Innisbrook Resort Membership Application Effective Date

Month Day Year
Please select your membership: *
Have you previously been a member at Innisbrook? *

Yes No
Innisbrook Lodge Owner
Lodge Name: Lodge Number:
Rental Pool Participant: Yes No
Highlands Owner
Lot Number: Lodge Number:
Closing Date:Date
Promontory Owner
Lot Number: Lodge Number:
Closing Date:Date
I hereby complete this application for the above referenced Membership at Innisbrook Resort and Golf Club herein referred to as “The Club” and do agree to pay the sum of
$Number*  as a one-time fee for Golf Memberships, or the first annual fee for Social or Tennis, each payable with application and subject to all applicable sales tax. Social and Tennis Memberships have a commitment of 12 full calendar months for the first year and will automatically continue with monthly dues and with subsequent annual fees, billed in advance, each year prior to the anniversary date.

Acknowledgment:   Signature   (please initial)

All Membership types shall continue until written cancellation is received by the Club pursuant to the terms herein.

I authorize The Club, to bill my credit card in the amount of: $   Number*
Signature *

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Applicant Information
Primary *

First Name Last Name
Date of Birth *

Month Day Year
type out date of birth in the following format: MM-DD-YYYY
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email *
example@example.com
Home Phone
Please enter a valid phone number.
Cell Phone
Please enter a valid phone number.
Employer: blanks* Employer Phone: Area Code Phone Number
Employer Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Spouse / Domestic Partner Information
Name

First Name Last Name
Date of Birthday

Month Day Year
Date
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email
example@example.com
Home Phone
Please enter a valid phone number.
Cell Phone
Please enter a valid phone number.
Employer: blanks Employer Phone: Area Code Phone Number
Employer Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Please select: *

Spouse Domestic Partner N/A
Domestic Partner Affirmation and Agreement
Affirmation

We, the undersigned Member and Domestic Partner state that: (a) the Domestic Partner has resided at Member’s primary residence for at least the past year, (b) we have a spousal relationship not evidenced by a marriage license but legally eligible to be married to the Member. As evidence of this spousal relationship, we offer the Club acceptable documents supporting this relationship.

Agreement

Based upon the above, the undersigned parties agree as follows:
1. The Domestic Partner is hereby entitled to have the same right of use of the Club facilities under the Code of Regulations as the Member and shall be provided with a membership card.
2. The Member and the Domestic Partner agree to be jointly and severally liable for all charges and fees incurred by the Domestic Partner while this membership privilege is in effect.
3. This membership privilege shall be subject to termination by the Member or by the Domestic Partner at any time by giving written notice to the Club. The membership privilege and liability hereunder shall stand terminated at the time the Club receives said notice. If this membership privilege exists at the date of death of Member, the Domestic Partner shall be deemed the widow or widower of the Member under this Code.
4. The Domestic Partner agrees to accept all responsibilities of membership as if he or she was a spouse of the Member.
5. The parties agree that this agreement shall have no effect upon the personal or contractual rights of the parties other than as set forth in this agreement.
AGREED TO and EFFECTIVE this date: Date but subject to cancellation or modification as provided in Section B 1 of Article II of the Code.
Signature of Applicant

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Print Applicant Name
Signature of Domestic Partner

Clear
Print Domestic Partner Name
Dependent Information
Dependent 1

First Name Last Name
Dependent 1: Date of Birth

Month Day Year
Date
Dependent 2

First Name Last Name
Dependent 2: Date of Birth

Month Day Year
Date
Dependent 3

First Name Last Name
Dependent 3: Date of Birth

Month Day Year
Date
Referred by:
Vehicle Information
Vehicle 1
Year: Number* Make: * Model: *
Color: * State: * License Plate #:
Vehicle 2
Year: Number Make: Model:
Color: State: License Plate #:
Vehicle 3
Year: Number Make: Model:
Color: State: License Plate #:
Credit Card & Bank References
Upon signing this application, I hereby grant permission to The Club to verify my credit status. I also grant permission to charge my credit card for any charges to my membership account that are more than 30 days past due. If accepted for membership, I agree to be bound and abide by The Club’s Code of Regulations of which I understand is subject to change by the Board of Governors; and I hereby acknowledge receipt of a copy of the present Code of Regulations. Membership in The Club is not transferable, except as provided in the Code of Regulations.
I acknowledge that I have been advised with respect to the following facts:
1. The privileges and related dues of the class of membership for which this application is made and the limitations of those privileges.
2. The Board of Governors reserves the right to amend the Code of Regulations from time to time and determine dues levels and fees on an annual basis.
3. The Board of Governors (or any committee designated by the Board) retains the right to discipline or suspend members of the Club for any conduct deemed by the Board of Governors to warrant such action.
4. If my application is accepted, the initiation fee or recurring annual fee (calendar based) is non-refundable. 5. Membership dues and other expenditures are due and payable within 30 days of billing date. A late payment charge may be assessed on all account balances, which are delinquent. Late payment charges use a monthly periodic rate of 1.5% based on the previous balance less payments and credits. The Annual Percentage Rate (APR) is 18%. Upon approval by The Club, this application and its terms shall constitute a binding contract. In the event that collection is necessary, the member shall be responsible for all collection-related fees including but not limited to, attorney’s fees and court costs of The Club, and venue shall be in Pinellas County, Florida.
6. If initiation fee is applicable, I agree to pay any initiation fee as detailed below.
7. Membership Cancellation— Cancellation of Membership releases all rights, interests and privileges in The Club and is outlined within the Code of Regulations. Cancellation requires submitting written notification to either the Innisbrook Membership office, emailing membership@innisbrookresort.com or by fax to 727.942.5203. Once written notification is received, membership will be cancelled at the end of the notification month. Member is financially responsible for dues, fees and any other charges incurred on account.
Cancellation policy acknowledgment (initials: Signature* )

IN WITNESS WEREOF, the applicant has executed this application as of Date*
Signature of applicant: *

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Signature of spouse or domestic partner:

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For Office Use Only
Approved on: Date Effective Date: Date
By:
Chairman, Board of Governors

Salamander Innisbrook, LLC | DBA Innisbrook Resort and Golf Club
36750 Highway 19 North | Innisbrook, FL 34684
Tel 727.942.5275 | Fax 727.942.5203
Membership #:
Effective Date:

Month Day Year
Date

Auto-Pay Option Form
Upon completing and submitting this application, I agree to the Auto Pay Option for this membership account. By choosing this option I will avoid possible late fees. During the first week of each month, member statements are emailed and I will have the option to review all monthly charges and inquire with any questions. My credit card on file will be billed the third week of each month for all outstanding balances listed on my statement.

Yes, I agree to Auto Pay No, I do not want to sign up for Auto Pay
Upon completing and signing this form, you have selected the Auto-Pay option for your Member account. It’s easy, and by choosing this option, you can avoid possible late fees.

During the first week of each month, you will receive a Member account statement. This allows you the opportunity to review your monthly charges and call or email if you have any questions. Around the 20th of each month, your credit card on file will be charged for the outstanding balance listed on your statement.
Print Name as it appears on credit card:
Signature of Applicant: *

Clear
Date *

Month Day Year
Date
Please remember to advise the Member Accounting Department at 727.942.5436 of any change in credit card information including the expiration date.

Thank you for choosing the Auto Pay Option for convenient monthly billing to your Credit Card.
For Office Use Only: BOG Approval
BOG Signature for Approval

Clear
Date

Month Day Year
Date
Should be Empty:

Innisbrook Resort Membership Application

Applicant Information

Spouse / Domestic Partner Information

Domestic Partner Affirmation and Agreement

Dependent Information

Vehicle Information

Credit Card & Bank References

For Office Use Only

Auto-Pay Option Form

For Office Use Only: BOG Approval