Newberry Estate Country Club
3 Newberry Estate, Dallas, PA 18612 ~ (570) 675-5236
2015 Membership Registration Form
Member Name ___________________________________________________ Spouse’s Name _______________________
Address _________________________________________ City, State ______________________ Zip Code ____________
Home Phone ____________________ Cell Phone ___________________ Email __________________________________
(all emails are sent BCC)
Please check your preferred method to receive information: EMAIL _________ Regular Mail ________
Membership - To get the most out of your membership please respond to questions below!
All Privilege (Includes Golf, Pool & Tennis) Family $920
Single $660
# of golf tags needed _______
I am interested in Golf League Information
Men’s
Ladies Mixed
Junior
I am interested in Golf Lesson Information
Yes
No
I am interested in Tennis League Information
Men’s
Ladies Mixed
Junior
I am interested in Tennis Lesson Information
Yes
No
Add my name and the following contact number to a published Tennis Player List _______________________________________
I am interested in swimming lessons
Yes
No
Golf
Family $585
Single $350
I am interested in Golf league Information
I am interested in Golf Lesson Information
Tennis
Family $225
Men’s
Yes
Single $125
Junior/Student $125
Ladies
No
Mixed
# of golf tags needed _______
Junior
Junior/Student $50
I am interested in Tennis League Information
Men’s Ladies
Mixed
Junior
I am interested in Tennis Lesson Information
Yes
No
Add my name and the following contact number to a published Tennis Player List ______________________________________
Pool (Includes Pool & Tennis)
Family $660
Single $390
I am interested in Tennis League Information
Men’s Ladies
Mixed
Junior
I am interested in Tennis Lesson Information
Yes
No
Add my name and the following contact number to a published Tennis Player List ______________________________________
I am interested in swim lessons
Yes
No
There is a $200 Initiation Fee in the first year of membership. (Does not apply to junior or tennis only memberships)
Family Members to include in Membership:
______________________________ Age __________
______________________________ Age __________
______________________________ Age __________
______________________________ Age __________
______________________________ Age __________
______________________________ Age __________
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Family Membership is made up of 2 or more people, including spouse and children.
One third of membership dues must be paid by each of the following dates: February 27th, March 27th, and April 24th.
Membership dues must be paid in full before any member may begin to use the facilities.
Indemnification Clause
I (We) ______________________________________, as a non-resident member, agree to personally indemnify, defend, and hold harmless Newberry
Estate Homeowners’ Association, Inc. and its’ managing agent from all damage, injury, and liability, cause or resulting from my (our) use and my (our)
guests use of the pavilion, pool area, golf course, tennis courts, parking lots and grounds. I (We), agree to abide by all the rules and regulations established,
and I (we) will ensure that my (our) guests will abide by those rules and regulations. Nothing herein shall release Newberry Estate Country Club from
liability arising from the negligence of its’ agents or employees for actions within the scope of their employment.
Member’s Signature: __________________________________________________ Date: ______________________
Referring Member’s Name: _________________________________________________________________________
HOW DID YOU HEAR ABOUT US? ________________________________________________________________