Leonard Country Club, 5274 153rd Ave Se, Leonard, ND 58052

2-Year Membership Application - (2018-2019)

 

Membership Information:

 

Member Name: _________________________________________

 

Media Source: ________________ (Where Did You Hear About This Promotion)

 

Address: _______________________________________________

 

City: ____________________ State: ______ Zip:  _______________

 

Birthday:  _______________

 

Phone Number: _________________

 

Email Address: _______________________________________

(Your email will be utilized by our Leonard Country Club staff for internal communication purposes only; and not shared with any other outside entity.)

 

Membership Acknowledgment:

 

*2 Year Membership Rate Details: $89/Year + $10/Year Admin Fee = $198.00+7.5% Sales Tax (Total Charge. = $212.85)

 

Option #1)

 

        Pay By Check:     Simply Mail Payment To The Address At The Top Of This Form.

Option #2)

        Pay By Credit Card:     Fill In Information Below & Mail To The Address At The Top Of This Form  -OR- Call 701-645-CLUB(2582)

Credit Card#: ___ ___ ___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___         

(M/C, Visa, or Discover)

Exp. Date: ___ / ___                                   CVV2#: ___ ___ ___ (3 Digit Code on Back Of Card)

 

Signature: _____________________________________         

 

Membership Expires on: December 31, 2019