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 IHHRIRQHDQGƓYHWHQWKVSHUFHQWDQQXDOUDWHZLOOEHFKDUJHGWRP\EDODQFHLILWLVQRWSDLGZLWKLQWKLUW\GD\VRIWKHVWDWHPHQWGDWH,IXUWKHUXQGHUVWDQGWKDWLIP\DFFRXQWLVVL[W\GD\VSDVWGXHP\PHPEHUVKLSVWDWXVZLOOEHWHUPLQDWHG&KDOOHQJHVWRFKDUJHVPXVWEHPDGHZLWKLQIRUW\ƓYHGD\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.