Dining • Social • Wellness Membership Application

Port Cunnington Lodge
2024 Dining • Social • Wellness Membership Application
Fee: $ $575 plus H.S.T.

    Applicants Name in full:*:

    Home Address:*:

    City*:

    Postal Code*:

    Phone:*:

    Cell*:

    Cottage Phone:*:

    E-mail*:

    Occupation:

    Name of Firm: (If using a company account please fill in the details)*:

    Business Address:*:

    City*:

    Postal Code*:

    Phone:*:

    Fax:

    Business E-mail*:

    Preferred Credit Card: Mastercard, Visa #*:

    Expiry*:

    CVC/CVV*:

    Date of Applicant’s Birth Month:*:

    Date of Applicant’s Birth Day:*:

    Date of Applicant’s Birth Year:*:

    If married, does spouse wish to have signing privileges?*:YesNo

    Full Name of Spouse:*:

    Date of Spouse's Birth Month:*:

    Date of Spouse's Birth Day:*:

    Date of Spouse's Birth Year:*:

    Spouse's E-mail*:

    Names and birth dates of additional immediate family members:

    Full Name of Family Member #1:

    Date of Family Member #1 Month::

    Date of Family Member #1 Birth Day::

    Date of Family Member #1 Birth Year::

    Full Name of Family Member #2:

    Date of Family Member #2 Month::

    Date of Family Member #2 Birth Day::

    Date of Family Member #2 Birth Year::

    Full Name of Family Member #3:

    Date of Family Member #3 Month::

    Date of Family Member #3 Birth Day::

    Date of Family Member #3 Birth Year::

    I agree:

    I certify that the particulars listed herein are true and correct. In consideration of being accepted as a candidate for a Dining • Social • Wellness Membership from Port Cunnington Lodge and entitlement to the privileges outlined in this brochure. I hereby agree that I will abide by the Lodge Guest Rules and Regulations (as amended from time to time) and I will pay when due, all debts to PCL Lodge incurred by myself, my family and my guests and that I will be responsible for their conduct on within the Lodge and on the Lodge premises.

    (Note: from time to time there are Block out of weeks in late July and weekends in May, June, September and October are unavailable as hosting on property guests and wedding guest weekends). These can be identified ahead of time on our online Calendar of Activities / Events.

    Signing privileges for Member and immediate family Members (Credit Card information and authorization required to post any outstanding amounts exceeding prescribed payment policies, an administration fee of 4% would be applied to the process. By signing this application you have provided authorization to process your credit card, accounts will automatically be settled to the credit card on file on 15th of the month (or whatever date you choose).

    Use of Resort designated docking facilities for daytime docking when dining or utilizing a day pass access.