CHAMPLAIN COUNTRY CLUB
SWANTON, VERMONT 05488
2010 SCHEDULE OF DUES AND FEES
DATE: _____________ DATE OF BIRTH:
NAME(S): ___________________________________________________________________________
ADDRESS: __________________________________________________________________________
TELEPHONE NUMBER(S): _______________________ E-MAIL _____________________________
Visit our WEB page at www.champlaincountryclub.com. New member referred by_________________ннн
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Pay by January 15 |
Pay by April 15 |
Paid after April 15 |
6 Installment Payments |
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SENIOR DUES ($798.00 plus tax) |
$824.68 |
$845.88 |
$877.68 |
$140.98 |
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HUSBAND & WIFE ($1,522.00 plus tax) |
$1,570.92 |
$1,613.32 |
$1,655.72 |
$268.89 |
FAMILY Ц Husband & Wife ($1,522.00 plus tax)Single Parent ($798.00 plus tax)1st Child (11-17) freeAdditional Children ($100ea--11-17)Under 11 free |
$1,570.92$824.68$106.00-0- |
$1,613.32$845.88$106.00 |
$1,655.72$877.68$106.00 |
$268.89$140.98$17.67 |
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GOLDEN (over 75 years old) Limited play option ($468.00 plus tax) |
$485.48 |
$496.08
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$511.98 |
$82.67 |
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YOUNG ADULT (Ages 18 - 22)* ($468.00 plus tax) *(Age is determined at January 1, 2010) |
$485.48 |
$496.08 |
$511.98 |
$82.67 |
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JUNIOR (11-17)* ($247.00 plus tax first child, $195.00 2nd child plus tax, $145.00 plus tax, 3rd child) *(Age is determined at January 1, 2010) |
1st $256.52 2nd $201.40 3rd $148.40 |
1st $261.82 2nd $206.70 3rd $153.70 |
1st $267.12 2nd $212.00 3rd $159.00 |
1st $43.64 2nd $34.45 3rd $25.62 |
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CLUB HOUSE CHIT (Required by Senior, Husband & Wife (2), and Golden) Total (Husband & Wife $200) |
$100.00 $200.00 |
$100.00 $200.00 |
$100.00 $200.00 |
$16.67 $33.34 |
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CART OWNER REGISTRATION (trail fees) |
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One user |
$250.00 |
$250.00 |
$250.00 |
$41.67 |
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Two users (includes Husband and Wife) |
$450.00 |
$450.00 |
$450.00 |
$75.00 |
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ANNUAL CART RENTAL (per seat) |
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Two Person (1 cart at a time) |
$650.00 |
$650.00 |
$650.00 |
$108.33 |
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Single (Riders must pay to ride cart) |
$350.00 |
$350.00 |
$350.00 |
$58.33 |
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DONATION FOR JUNIOR PROGRAM |
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Plus installment charge $5.00 per payment total $30.00 |
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$5.00 |
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Enter Amount Paid: |
$ |
$ |
$ |
$ |
TO ENSURE CREDIT TO THE CORRECT ACCOUNT, PLEASE RETURN THIS SCHEDULE
WITH YOUR PAYMENT AND CIRCLE AMOUNTS BEING PAID.
DUES MUST BE PAID BY APRIL 15 TO RETAIN MEMBERSHIP.
SIX INSTALLMENTS DUE MONTHLY STARTING JANUARY 31, 2010
VISA / MASTERCARD / DISCOVER ACCEPTED FOR PAYMENT
Enter Credit Card Name Number
Exp. Date Signature
Three digit id number from back of card_________________ Revised 11/09