_______________________________________ Name		_______________________________________ Spouse or significant other’s
_______________________________________ Address		_______________________________________ City, State, Zip
_____________ Member's Birth Date		_______________________________________ New Member's email address
_____________ Spouse's Birth Date		_______________________________________ Spouse's email address
__________________________ Phone number
List Children under 21 names _______________________________________ _______________________________________

 

I am seeking to join Quarry Stone as a month-to-month member for a period of one year on the first day of the month following today’s date of, _________________________.  I would like to become a member in the category that I have checked below.   Corporate memberships – separate form.

 

Membership		Age Range		Current Dues Rate
__ Full Member		40-64		$ 115.00 a month
__ Social Member		40-64		$ 57.50 a month
__ Full Senior Member		65 or over		$ 60.00 a month
__ Social Senior Member		65 or over		$ 32.50 a month
__ Full Junior Member		under 40		$ 60.00 a month
__ Social Junior Member		under 40		$ 32.50 a month
				(+ tax on all memberships)

 

I understand that, if my age category changes, I will be subject to the dues structure set for that category of membership on the first of the month following the birthday that causes my membership status to change. 

 

I understand that the dues are set by the board of directors of Quarry Stone, and that they may change at any time.  If dues are raised, I will have the option to either pay the new dues assessed, or I can elect to drop my membership at any time without further penalty upon settling my account balance in full.  Should I elect to resign as a member of Quarry Stone, I will do so in writing by the end of the last month that I choose to belong.  I agree to pay my initial dues in advance as well as a deposit of one-month’s dues for a total of double the amount of the dues shown in the category I have selected above.  I understand that if I continue my membership for twelve (12) consecutive months, the deposit paid at this time will be considered my 12^th month’s dues payment.  If I elect to discontinue my membership prior to twelve months of continuous membership, I understand that I will not receive this deposit back.   

 

It is my understanding that an offering to buy stock in Quarry Stone will be made to me at a future date and that I will have a choice to either become a stockholder in Quarry Stone at that time by purchasing said stock, or remain a month-to-month member without voting privileges at meetings of the stockholders.  (The date of this stock offering has not yet been established.) 

 

I also understand that I may remain a month-to-month member indefinitely.  However, should I drop my membership, in order to rejoin, I will need to wait a period of twelve consecutive months or pay the back dues to the time I resigned the club to be reinstated. I am seeking credit from Quarry Stone.  I agree to pay all of my account charges in full by the fifteenth of the month following the month when the charges are made.  I understand if my account if overdue for 30 days or more, that my CREDIT PRIVILEGES AND MY MEMBERSHIP PRIVILEGES WILL BE SUSPENDED until my account is settled.  I understand that I can settle my account by cash, personal check, credit card, or money order.  I also agree, if the club has to seek legal assistance to collect on my account, to pay all the fees in full as well as the court costs and attorney fees of Quarry Stone in collecting the amounts due.