Please enable JavaScript in your browser to complete this form.Name *FirstLastMember Number (if known)Mailing Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *Phone *Emergency Contact Name and Phone NumberChildFirstLastChildFirstLastChildFirstLastChildFirstLastI acknowledge the Fort Dodge Country Club Pool Membership is a seasonal membership for pool privileges. The Membership Fee will be paid in one full payment of $575.00 plus 7% Sales Tax or $575.00 plus 7% Sales Tax. The registered member may elect to have charging privileges for F & B in the Pro Shop. A monthly statement of charges will be mailed or available via email. Account statements are payable upon receipt. Member statements with balances aged over 30 days will have charging privileges revoked until paid in full. I authorize my Pool registration/Member number to have charging privileges and further authorize named children to the same. I do not hold Fort Dodge Country Club liable for charges incurred by unauthorized family members or guests named above.Signature *Today's Date *Pool Rules and Regulations A certified lifeguard will be on duty through-out the daily hours of pool operation. Members and guests are to respect and obey all lifeguard directions. Members and Guests are required to sign-in at the Pool. If the temperature at 10 am does not show it will be above 72 degrees by 12, noon, the pool will be closed until 2 pm. If the temperature does not show it reaching above 72 by 2 pm, it will remain closed for the day (source will come from weatherchannel.com). Guests must be accompanied by a Member. Daily guest fees are $7 per person per day. Pool & Social Membership (No Golf) $575 + 7% Sales Tax Submit
