Membership Application
CRESTLINE WALTON LAKE COMPANY
2019 NEW SOCIAL MEMBERSHIP
PLEASE PRINT:
FIRST NAME: ______________&________________ LAST NAME____________________________________
ADDRESS: ____________________________________ CITY/ZIP____________________________________
EMAIL ADDRESS: _________________________________________ PHONE: (______) _______-___________
PLEASE LIST THE NAME(S) AND AGES OF DEPENDENT CHILDREN LIVING AT HOME.
NOTE: ANY CHILD MARRIED OR 22 AND OLDER MUST HAVE THEIR OWN MEMBERSHIP.
NAME AGE NAME AGE
___________________________ _______ _____________________________ _______
__________________________ _______ _____________________________ _______
___________________________ _______ _____________________________ _______
NOTE: I AM BABYSITTING: Under 10 years of age $35.00 each
NAME____________________________________________ AGE______________________
NAME____________________________________________ AGE______________________
NEW MEMBERSHIP FEES:
SINGLE OR MARRIED WITH CHILDREN $225.00
SINGLE OR MARRIED WITHOUT CHILDREN $200.00
SENIOR CITIZEN (62 YEARS MIN.) $150.00
Two Character References:
Name: ____________________________________ Phone # __________________________
Name: ____________________________________ Phone # __________________________
Please mail your completed application with a check payable to:
Walton Lake Co.
P.O. Box 265
Crestline, Ohio 44827
By signing the application, I agree to abide by all the Rules and Regulations of the Crestline Walton Lake Company. Membership in this organization is limited to members in good standing. Anyone violating the rules will be asked to forfeit their membership and shall be barred from all privileges of Crestline Walton Lake Company.
Signature ______________________________________________ Date ______________________
For Walton Lake Company use only:
Date Paid: ____________________________________
Amount: ____________________________________
Check #: ____________________________________
Membership # ________________________________
