City Club at River Ranch National Membership

City Club at River Ranch National Membership Application

City Club at River Ranch National Membership ($5,000 Initiation + $50 Monthly)
Member Name*
Spouse Name
Primary Street Address*

Primary Street Address

Street Address Line 2

City, State, Zip CodeState / Province

Postal / Zip Code
Second Home Address

Second Home Address

Street Address Line 2

City, State, Zip CodeState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Company Name
Email Address*
example@example.com
Home Phone*
Business Phone
I, as the applicant, have enrolled in the National Club Membership of City Club at River Ranch, a Platinum Club of America® and Platinum Club of the World® which includes a 5-year subscription to PlatinumClubNet™ and PrivateClubWorld™. By signing up. I understand that my privileges are subject to the City Club at River Ranch terms and conditions, which are available through the Membership office. By signing below, I acknowledge that all service charges are required to be paid at the time of service by major credit card or other forms of payment acceptable to the facility participating in the program. Should I fail to do so, I agree that City Club at River Ranch may terminate my National Club Membership immediately and on such termination my subscription to PlatinumClubNet™ and PrivateClubWorld™ will also be terminated. I understand if the credit card company rejects any charges, I may be subject to reasonable collection fees and late charges as allowed by law. I agree to conform to and be bound by the Bylaws and Rules and Regulations of City Club at River Ranch as they may be amended from time to time. The above authorizations shall remain in effect as long as I participate in the National Club Membership. I understand that this membership is only available to those individuals who reside outside of Louisiana and includes full membership privileges including access to dining areas and special events plus preferred pricing at Riverspa and The Carriage House Hotel only. By signing, I agree to a print/digital media release of any photos/videos that may be taken of me while spending time at City Club at River Ranch.

Cancellation for City Club at River Ranch National Club Membership is required in writing & takes effect after 30 days.
Member Signature*

Clear
Date*

MonthDayYear
Date

Automatic Payment Program

City Club at River Ranch is pleased to offer members two options for the automatic payment of membership accounts. Payments will be posted on the first of every calendar month, and statements can be viewed online throughout the month to ensure accuracy of transactions on each account.Please fill out the appropriate information below and email form to membership@cityclubrr.com, or mail form to City Club at River Ranch1100 Camellia Boulevard, Ste. 202 Lafayette, Louisiana 70508.
Choose your Payment Type*

Automatic Bank Draft (Recurring)Automatic Credit Card Draft (Recurring)

Automatic Bank Draft (Recurring)
Attach a voided copy of a check from your checking account (deposit slips do not suffice). Authorization Agreement for PreauthorizedPayments (ACH Debits) I(we) hereby authorize City Club at River Ranch, hereinafter called COMPANY to initiate debit entries to my (our)Checking account indicated below, and the depository named below, hereinafter called DEPOSITORY, to debit such account
Upload Copy of a Voided Check

Cancelof
Depository Name
City, State, Zip
Transit/ABA No
Account Number
This authority is to remain in full force and effect until COMPANY has received written notification from me/us of its termination in such timeand in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act upon it
Name (printed)
Signature

Clear
Date

MonthDayYear
Date

Automatic Credit Card Draft (Recurring)
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Credit Card Type
Type a question
Card #
Upload Pic of Valid Government ID

Cancelof
I authorize City Club at River Ranch to bill account charges to the credit card on file the first of each month. I acknowledge that allcredit card transactions will incur an additional 3% service fee.
Printed Name
Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

Automatic Payment Program