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B&T Membership ApplicationName: (Last) _________________________________ (First)_____________________________ Birth Date ______/______/______ Street Address __________________________________________________ City ___________________________State: ____________Zip:___________ Cell Phone ___________________________________ Email Address___________________________________________________ Home Phone _________________________________ How did you hear out about the Oak Brook Bath & Tennis Club? _____________________________________________________________________ Name of Family Member Relationship Birth Date ____________________________________________________________________________/_______/_______ ____________________________________________________________________________/_______/_______ ____________________________________________________________________________/_______/_______ ____________________________________________________________________________/_______/_______ ____________________________________________________________________________/_______/_______ ____________________________________________________________________________/_______/_______ Membership Application I agree to the following terms: (1) To assume responsibility for credit extended by the Sports Core on the basis of this membership; (2) To comply with the rules and policies governing the operation of the Sports Core (see Title 12 of the Village Code of Ordinances entitled, “Village Recreational Facilities”); (3) To pay the Sports Core for all purchases made and credit obtained by any person included on this membership; (4) To notify the Sports Core promptly in writing of loss of the membership card(s) or any changes in address or telephone number. I understand that an interest IHHRIRQHDQGƓYHWHQWKVSHUFHQW   DQQXDOUDWH ZLOOEHFKDUJHGWRP\EDODQFHLILWLVQRWSDLGZLWKLQWKLUW\  GD\VRIWKHVWDWHPHQWGDWH,IXUWKHUXQGHUVWDQGWKDWLIP\DFFRXQWLVVL[W\  GD\VSDVWGXHP\PHPEHUVKLSVWDWXVZLOOEHWHUPLQDWHG&KDOOHQJHVWRFKDUJHVPXVWEHPDGHZLWKLQIRUW\ƓYH  GD\VRIWKHVWDWHPHQWGDWH,KHUHE\JUDQW permission to the Village of Oak Brook to use photographs of individuals listed on this application, without further consideration, and hereby release the Village of Oak Brook and its WUXVWHHVRIƓFHUVHPSOR\HHVDQGOHJDOUHSUHVHQWDWLYHVDQGDVVLJQVIURPDQ\DQGDOOFODLPVDFWLRQVDQGOLDELOLW\UHODWLQJWRLWVXVHRIVDLGSKRWRJUDSKV Part 4 - Review & Sign Applicant’s Signature Date Unlimited Memberships Resident FeeTFamily Swim & Tennis TIndividual Swim & Tennis TSenior Couple Swim/ Tennis TSenior Individual Swim/Tennis b Corporate Resident FeeTFamily Swim & Tennis TIndividual Swim & Tennis  Non-Resident FeeTFamily Swim & Tennis TIndividual Swim & Tennis TSenior Couple Swim & Tennis TSenior Individual Swim/ Tennis  Part 2 - Type of Membership Part 1 - Name & Address of the primary member In-House ChargeT,KHUHE\DXWKRUL]HDQ,Q+RXVHFKDUJH account. I understand that my credit card or debit card will be automatically debited for DOOLQKRXVHFKDUJHV Applicant's initial ______________________ Tennis Memberships FeeTFamily TIndividual TSenior +1 TSenior Individual TNonresident Family TNonresident Individual  Completed applications can be mailed to Oak Brook Village Hall, 1200 Oak Brook Road, Oak Brook, IL 60523 You can also fax your membership with payment to: 630-368-6425 Ƒ Early Bird Rate (Due by May 1) Part 3 - Payment Options Cash Check To make a payment with a credit card, you may register at a registration desk or call 630.368.6426 with your credit card information.