JUNIOR & DIVOT MEMBERSHIP APPLICATION – 2025

I, First Name* Last Name*

hereby apply for the following membership

Date of Birth

Date

Classification – Golf*

DIVOT (7 - 11 YEARS OF AGE AS OF JAN. 1) – $352 + hst (Divots must be supervised by an adult at all times while on club property)JUNIOR (12 - 18 YEARS OF AGE AS OF JAN. 1) – $497 + hst

PLEASE NOTE: JUNIOR/DIVOT ANNUAL DUES WILL BE AUTO-RENEWED IN JANUARY. PLEASE ADVISE PRIOR TO THIS IF YOU WILL NOT BE RETURNING.

Permission*

I am a parent/guardian of the divot/junior member applying for this membership hereby grant permission to have his/her picture taken for publication solely to Peterborough Golf and Country Club’s member website, within the Clubhouse and/or in our monthly newsletter.I understand that the Junior Member must be linked to an Adult member of the club.

Signature*

Member Information

Name*

PrefixLastFirst

Address*

Street Address

Street Address Line 2

CityProvince

Postal Code

Phone Number:*

Area CodePhone Number

Alternate Number:

Area CodePhone Number

Email*

Parent or Guardian Email Address*

example@example.com

Work Email:

Application Acceptance & Agreement

Please check to identify the acceptance of the following statements:*

I understand the details and promise to pay all annual dues/fees/assessments that apply to my membership scheduled for this application.I agree to follow all By-Laws and Regulations of the Club and any other resolutions passed by the Club.

Name of the Linked Adult Member and Type of membership they hold (Example - John Smith - Social) Name* Category*

Payment Options

Please indicate your preferred method of payment for your account.*

Pre‐authorized Debit to Bank (PAD form to be completed)E‐Transfer (notification to be sent to accounting@ptbogolf.com)Online Banking

In the event of a delinquent account any Member that shall neglect or fail to pay the prescribed Annual Fee, the initiation Fee, any assessment levy, house account or any other indebtedness to the Club for more than thirty days after the same shall be due, the Board may, without notice, withdraw all privileges of such member.

I have read and understand the terms and conditions of the past 30 days indebtedness, as indicated above.

Signature*

PLEASE NOTE: All dues are ‘Auto‐renewed’ annually in January unless we are notified otherwise. Any change/cancellation of membership must be received no later than December 31.

Once you submit your application, we will contact you shortly to complete your membership application.

Thank you!