Membership Application - Poughkeepsie Tennis Club

* Membership Type:

Full Name:

* Today’s Date:

* Email Address:

* Phone:

* Address:

* City:

* State:

* Zip Code:

Applicant

* Full Name:

* Nickname:

Interested In:

Tennis

Squash

Pool

* Date of Birth:

Spouse

Full Name:

Nickname:

Email Address:

Phone:

Interested In:

Tennis

Squash

Pool

Date of Birth:

Child

Full Name:

Nickname:

Interested In:

Tennis

Squash

Pool

Date of Birth:

Child

Full Name:

Nickname:

Interested In:

Tennis

Squash

Pool

Date of Birth:

Child

Full Name:

Nickname:

Interested In:

Tennis

Squash

Pool

Date of Birth:

Child

Full Name:

Nickname:

Interested In:

Tennis

Squash

Pool

Date of Birth:

Profession or Business

* Applicant:

* College:

* Employer:

Spouse:

College:

Employer:

* Length of Time in Area:

* Previous Residence & Work:

* Local Community Activities:

* Skills/Hobbies:

* Where did you learn about us?

* List any club members with whom you’re acquainted.

Part of having the full member experience of the PTC is being able to charge directly to your account for food and beverage, indoor tennis court fees or tennis lesson fees, items from the Pro Shop, etc. In order to provide you with the full member experience, we need to keep your credit card or bank account information on file to pay your account balance each month. Here’s how recurring payments work: you authorize regularly scheduled charges to your checking/savings account or credit card based on your statement balance. Your statement will be emailed to you, and you will be charged each billing period for the total amount due for that period. All new members need to keep their recurring payment information on file in our secure payment system. I authorize Poughkeepsie Tennis Club charge OR debit my account on the second Thursday of the month for payment of my dues, food and beverage, court fees, tennis lessons, pro shop purchases and other charges. I understand that this authorization will remain in effect until I cancel in writing, and I agree to notify Poughkeepsie Tennis Club in writing of any changes in my account information or termination of this authorization at least 15 days prior to the next billing date. If the above noted payment date falls on a weekend or holiday, I understand that the payment may be executed on the next business day. For ACH debits to my checking/savings account, I understand that because these are electronic transactions, these funds may be withdrawn from my account as soon as the above stated periodic transaction dates. In the case of an ACH transaction being rejected for Non-Sufficient Funds (NSF) I understand that Poughkeepsie Tennis Club may at its discretion attempt to process the charge again within 30 days, and agree to an additional $25 charge for each attempt returned NSF which will be initiated as a separate transaction from the authorized recurring payment. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this credit card/bank account and will not dispute the scheduled transactions with my bank or credit card Company; provided the transactions correspond to the terms indicated in this authorization form.

* Payment Preference:

Credit Card

* Dues Billing Preference:

* Your Signature

* Date: