Property Owner Name *

First Name

Last Name

Name of Adult 1 *

First Name

Last Name

Access Type for Adult 1 *

Select one option

Annual Fee

Discounted Green Fees

Jack's Point Home Course for Adult 1

Players who nominate Jack’s Point as their home course will be charged the annual levies for Golf NZ, Golf Otago and Golf Central Otago and Admin Fees through the Jack’s Point Golf Course.

Yes

No*

Name of Adult 2

First Name

Last Name

Access Type for Adult 2

Select one option

Annula Fee

Discounted Green Fees

Jack's Point Home Course for Adult 2

Players who nominate Jack’s Point as their home course will be charged the annual levies for Golf NZ, Golf Otago and Golf Central Otago and Admin Fees through the Jack’s Point Golf Course.

Yes

No*

Name of Youth 1

First Name

Last Name

Access Type for Youth 1

Select one option

Annual Fee

Discounted Green Fees

Jack's Point Home Course for Youth 1

Players who nominate Jack’s Point as their home course will be charged the annual levies for Golf NZ, Golf Otago and Golf Central Otago and Admin Fees through the Jack’s Point Golf Course.

Yes

No*

Name of Youth 2

First Name

Last Name

Access Type for Youth 2

Select one option

Annual Fee

Discounted Green Fees

Jack's Point Home Course for Youth 2

Players who nominate Jack’s Point as their home course will be charged the annual levies for Golf NZ, Golf Otago and Golf Central Otago and Admin Fees through the Jack’s Point Golf Course.

Yes

No*

Agreement

I/We confirm that the persons named are entitled to take up Golf Access (see below for who is entitled to take up Golf Access) and, if taking up the annual fee option, we agree: • To our names being available to other’s for golf purposes, • That the information provided here is correct and that the persons nominated are Eligible Persons as set out in the Jack’s Point Constitution, • To abide by the rules of the Jack’s Point Golf Course, • That adult players are responsible for youth players, • Access is limited to those persons whose accounts are fully paid by the due date.

I/We agree to the undertaking and acknowledge the above terms.