Community Center : Membership Agreement - 1 Year Contract

Membership Agreement - 1 Year Contract

Please fill out the following form to register for a 1-year membership at the Brushy Creek Community Center. Once you click the submit button below, your request will be sent to Customer Service who will contact you within one business day to collect payment information.

MEMBER INFORMATION:
Last Name:		First Name:		M.I.:
Street Address:		City:		Zip:
Home Phone:		Cell Phone:		DOB:
Email Address:		Allergies:		Sex:	M F

Would you like to receive information from the Community Center via email? Yes No
EMPLOYER INFORMATION:
Employer:		Work Phone:

EMERGENCY INFORMATION:
Name:		Phone:		Relation:
Name:		Phone:		Relation:

FAMILY MEMBERS:
Last Name	First Name	Birth Date	Sex	Allergies
			Male Female
			Male Female
			Male Female
			Male Female
			Male Female
			Male Female
			Male Female
			Male Female

MEMBERSHIP AND PRICING OPTIONS:
Senior:		Annual	Quarterly **	Monthly **
Resident Senior Pass		$5	---	---
Regular:
Resident Individual *		$150	$42.50($170) **	$17.50 ($210) **
Non-Resident Individual *		$300	$80 ($320) **	$30 ($360) **
Resident Family *		$400	$105 ($420) **	$38.50 ($462) **
Non-Resident Family *		$800	$205 ($820) **	$72 ($864) **
District:
Resident District Pass Individual *		$220	$60.00 ($240) **	$23.50 ($282) **
Non-Resident District Pass Individual *		$435	$113.75 ($455) **	$41.25 ($495) **
Resident District Pass Family *		$530	$137.50 ($550) **	$49.25 ($590) **
Non-Resident District Pass Family *		$1,060	$270 ($1,080) **	$93.50 ($1,120) **
* All New and Renewed (over thirty (30) days of expiration) Memberships require a $25 Activation Fee.
** Only available to members that pay by credit card.

CONTRACT TERMS: 1) I understand that I am signing a binding contract with Brushy Creek Municipal Utility District that will automatically renew on an annual basis. 2) I understand that the minimum membership term is 12 months and this contract may not be cancelled or terminated by a member during the initial twelve (12) months. After the first 12 months, the contract may be terminated with 30 days prior written notice. 3) In the event I have selected payment by debit/credit card, I authorize Brushy Creek MUD to charge my bank/charge account according to the payment plan I have selected. I further agree that in the event payment is not honored by my financial institution (Credit Card Company or Bank) for any reason, I am still responsible for payment plus a service charge to be assessed by the District, in addition to any service charges my financial institution (bank or credit card company) may charge. 4) I understand that my membership and other Brushy Creek MUD privileges are subject to suspension or termination in the event any membership dues remain unpaid for 30 days. 5) I agree that I have been informed that the Community Center Policies and Rules (Membership Policies and Code of Conduct) are posted on the District's website (See link below), and I have had an opportunity to review such policies and rules. I agree that such policies are a part of this contract. I further acknowledge and agree that violation of the Community Center Policies and Rules (Membership Policies or Code of Conduct) by me or my family member(s) or my guest(s) may result in the suspension or termination of membership privileges, termination of privileges of use or other Brushy Creek MUD facilities, and/or criminal or civil prosecution (for conduct in violation of the Laws of the State of Texas). 6) I agree the Board of Directors of the District may change policies, rules and regulations at any time. Any change in membership fees will become effective with 60 days notice given on our website. An email notification will also be sent to current members who have an email address on file with us. 7) I assume full responsibilities for any property damage or personal injury caused by me or my family members. 8) I agree to assume sole responsibility, and to release and hold harmless Brushy Creek MUD, for any personal injury or losses sustained by me or my family members while on the Community Center Premises. 9) I agree to indemnify Brushy Creek MUD, its Directors, Employees, Contractors, Agents and Representatives for any costs, claims, damages, demands, losses and causes of action, including reasonable attorneys' fees, arising out of or related to any personal injury sustained by me or my family member(s) or my guest(s) participating in recreational activities or utilizing any of Brushy Creek Municipal Utility Districts properties. Membership Policies & Rules I agree to the Contract Terms and Membership Policies: Signature: Date:

Customer Service will call you to obtain payment information.