Forms & Rules

Affiliate Family Membership Application

* - denotes a required field

Applicant Name *
Address *
City *
State *
Zip *
Home Phone: * - -
Work Phone: - -
Email Address *
Name of Sponsoring Cummins Employee/Retiree *
Clock Number
Relationship to Applicant *
Type of Membership (Pick One From Each Column) *
New
Renewal 		Regular
Gold Single / Family
Gold+ Single
Gold+ Family
Sports & Fitness Single
Sports & Fitness Family
Sports & Fitness Senior
Gold GOLF Single / Family
Gold+ GOLF Single
Gold+ GOLF Family

How would you like to receive your membership cards? *
Mail them to my home address.
I will pick them up at the Sports & Fitness Center upon my next visit.

ELIGIBLE FAMILY MEMBERS

An eligible family member may include a spouse (or recognized domestic partner, if approved by your company) and children 20 years old and under (not married) living in the same house as their parents. Children 21 years old and over with student status and a current student ID (not married) living at home may also be included. All other individuals not listed above are considered guests and must be accompanied by a CERA member.

First Name M.I. Last Name Relationship Age Birth Date

Agreement

By the submitting this application, I hereby confirm that the above information is true and correct. I further understand that if the above information is determined to have been falsely stated, I will forfeit my CERA privileges.

Furthermore, I understand that all members must present their membership cards upon entrance to the Park, the Sports & Fitness Center, and all outdoor facilities. Children 3 years of age and under are admitted without I.D. cards when accompanied by adult members.

Furthermore, I agree to uphold all the CERA Rules and Regulations and will enforce them with any of my guests and / or dependants. I understand that any persons displaying objectionable behavior and / or violating the rules may be removed from the park by CERA Management and may result in the termination of my park privileges.

By submitting this application, the sponsoring employee or retiree and the above applicant are both certifying that the applicant is a son, daughter, parent, grandparent, grandchild, brother, or sister of the sponsoring employee or retiree and that the listed dependents are direct family members of the applicant. Both parties acknowledge that if the above information is determined to be false, the applicant is ineligible for participation and the sponsoring employee or retiree will forfeit their Ceraland privileges.

By submitting this application, I, the participant, parent or legal guardian, hereby agree to waive, release and indemnify Cummins Employees Recreation Association, Inc., its Board of Directors, Officers, Agents and Assigns from any and all claims, demands, actions or suits (including, but not limited to costs and attorney’s fees), arising out of any injury, death, damage or loss which might be sustained by me, my dependants or any persons as a result of my participation in this membership program.

By submitting this form, I, the participant, hereby agree to a minimum of one year (12 months) membership or until the end of the membership year. I may elect to discontinue my membership after that time has elapsed. Should the account be referred for collection, the applicant shall pay reasonable attorney\'s fees and costs of collection.

Furthermore, I acknowledge that I have read and understand the above agreement.

Applicant's Name *

(By filling in your name, you are acknowledging the same as a written signature of acceptance)

Date Submitted

 

Affiliate Family Membership Program

Those persons eligible for the Affiliate Family Membership Program are sons, daughters, parents, grandparents, grandchildren, brothers, and sisters of Ceraland eligible ACTIVE, RETIRED, or DECEASED Cummins, Inc. employees.

This program will allow eligible family members to obtain a Ceraland membership and have full use of all Ceraland activities and programs. Exception: Programs organized for the exclusive use of Cummins employees.

How to Apply for Affiliate Family Membership

The applicant / family member must be sponsored by a current Ceraland eligible CECO employee or retiree. If the CECO employee is deceased, the family member may enroll by producing his / her birth certificate showing the CECO employee as parent.

The sponsoring member (if not deceased) and applicant must bring the completed form to the Ceraland Park Office. The sponsoring member (if not deceased) must verify company employment by presenting a Cummins ID card. If a sponsoring employee or retiree cannot be present due to relocation, a notarized signed application will be accepted upon eligibility verification. Note: The sponsoring member does not need to be present anytime after the initial application has been approved.

Affiliate Family Memberships will be valid for one (1) year from the date of purchase. Cost of the family membership will be $150.00 per single / family. The payment must accompany the application. Should the account be referred for collection, the applicant shall pay reasonable attorney's fees and costs of collection. All other CERA fees apply. Upon verification of the member and payment, ID cards will be issued to the requesting application and family members if eligible.

Renewal Process & Late Fee

A renewal notice & application will be sent 30 days prior to the expiration date. Sign and return the application with the renewal fee to the CERA Park Office by the expiration date. If the application and fee are not received within 30 days after the expiration date a $25 late fee will be charged upon next sign-up.

Membership Upgrades

Gold Membership
This pass entitles CERA members and their immediate eligible family members to unlimited usage of the Ceraland aquatic center, miniature golf, boat dock activities and rifle range for the entire membership year.
Annual Fee: $275 or Monthly Fee: $24
Gold+ Membership
This pass entitles CERA members and their immediate eligible family members to unlimited usage of the Ceraland aquatic center, miniature golf, boat dock activities, rifle range and the Sports & Fitness Center (league nights included) for the entire membership year.
Annual Single Fee: $340 or Monthly Fee: $30
Annual Family Fee: $380 or Monthly Fee: $33
Sports & Fitness Center Membership
This pass entitles CERA members and their immediate eligible family members to unlimited usage of the Ceraland Sports & Fitness Center (league nights included) without paying individual admission fees.
Annual Single Fee: $270 or Monthly Fee: $24
Annual Family Fee: $310 or Monthly Fee: $27
Annual Senior(55+) Fee: $240 or Monthly Fee: $21
Gold GOLF Membership
This pass entitles CERA members and their immediate eligible family members to unlimited usage of the Ceraland aquatic center, miniature golf, boat dock activities and rifle range for the entire membership year. IN ADDITION, you receive one (1) Otter Creek Golf Course Players Card which includes discount golf rates for the calender year.
Annual Fee: $400 or Monthly Fee: $35
Gold+ GOLF Membership
This pass entitles CERA members and their immediate eligible family members to unlimited usage of the Ceraland aquatic center, miniature golf, boat dock activities, rifle range and the Sports & Fitness Center (league nights included) for the entire membership year. IN ADDITION, you receive one (1) Otter Creek Golf Course Players Card which includes discount golf rates for the calender year.
Annual Single Fee: $490 or Monthly Fee: $42
Annual Family Fee: $530 or Monthly Fee: $46