ANNUAL MEMBERS CLUBHOUSE REGISTRATION FORM

DOCUMENT REQUIRED:
A form of identification is required for each individual applying for the Clubhouse Access Key Card.

Annual Member Club dues are $980.00 on a fiscal year basis based on the District s fiscal year, which runs from October 1st through September 30th of the following year.

Additional Key Cards (per Section 1.7 of Club Rules) are $40.00 Replacement Key Cards are $10.00

Money Order or Cashier Checks Only, Made payable to Palm Glades CDD.

Name of Primary Annual Member:	Property Address:	
Phone Number(s):	Email Address(s):	

List up to (2) two Immediate Family Members and any minors residing on property	
Date of Birth	OFFICE USE ONLY
Key Card Number	

			

			

I acknowledge that I have received, read, and understood the Clubhouse Rules and Regulations.

I have received an access Key Card and understand that I will be denied access to the club facilities if I cannot present the access key card at the front desk. I understand that this key card is not transferrable and only I may be able to use this key card to gain access to Club Silver Palms.

If my Key Card is lost, damaged, or stolen, I will contact the Clubhouse immediately to terminate that access key card and will purchase a replacement in the amount stated above.

Signature: 	

Print Name: 	

Date: 	

CLUB DUES, FEES AND CHARGES

CATEGORY	AMOUNT	
		
ANNUAL MEMBER CLUB DUES	Residents (1)	*$895.05	
		
ANNUAL MEMBER CLUB DUES	Non-Residents	*$980.00	
		
GUEST PASS FEE	$10.00	
		
PERSONAL TRAINER FEE	$10.00	
		
LEASE APPLICATION PROCESSING FEE	$50.00	
		
MEMBERSHIP CARD REPLACEMENT FEE	$10.00	
		
ADDITIONAL MEMBERSHIP CARDS (per Section 1.7
of Club Rules)	$40.00	

*	Annual Member club Dues   fiscal year, which runs from October 1st through September 30th of the following year.
.

(1) Residents Club Dues are levied by the District within the		property taxes. Accordingly, the Tax Collector fees and early payment discounts may vary the annual Club Dues from the amount set forth above.	For purposes of
Membership and Annual Dues, there shall be only one Member per Home.

2