Exhibit 111 — USA v. McCabe (Dkt. 91.118)

Summary

Filed as Document 91-118 in United States v. McCabe, Case 9:24-cr-80103-AMC, and entered on the docket March 10, 2025 in the U.S. District Court for the Southern District of Florida, this government exhibit is a six-page PGA National Members Club membership application footed “MCCABE PGA RESORT APPLICATION”, covering candidate information, the membership category and joining cost, payment of the membership account and the club’s membership policies, including a release of the club from liability. It authorizes the club to check the applicant’s credit and employment history, requires 30-day written notification for resignation and reproduces the club’s dress code policy.

Summary drafted by a model from the document's text below and checked by script against that text before publication. It is a navigation aid, not a reading of what the document proves. Where AI is used

Record facts

Full text

Case 9:24-cr-80103-AMC   Document 91-118   Entered on FLSD Docket 03/10/2025   Page 1 of 6
aacee

40uvay

PGA NATIONAL MEMBERS CLUB MEMBERSHIP APPLICATION

CANDIDATE INFORMATION Mr. GQ Mrs. QO Ms. Q Dr.
Primary Candidate Destin ¢ abe Today's Date 'R TAry 80OL
Home Address © Vromygarde wey At ier Date of nt”
City Jvor te State “2 Zip 3 34"S
Home Phone Cell Phone SU! -4 7 %-!23? Local Phone
Local Address
City State Zip
Marital Status > Single o Married Wedding Anniversary Date
Social Security # (last 4 digits) ~? S |? Driver's License # State
re, (Copy to be pevided at game of application}
Business Name__ >< Type of Business {aN eves
Title 221 + Length of Employment _{ _ (yrs) Business Phone $4! -& D& - 1930

Business Address_(72’> Wen tntde Yay Hise

City fog te State © C Zip 3345 Business E-mail

Personal e-mail Send Club Emails to this address C14 ¢ She 1? 2972 ge htua
a ~Q Mr. Q Mrs. OQ Ms. O Dr.

Spouse/Spousal Equivalent/Significant Other Date of Birth f !

Social Security # (last 4 digits) Driver's License # State

Home Phone Business Phone CellPhone.

Business Name Type of Business

Title Length of Employment (yrs)

Personal e-mail Send Club Emails to this address

List unmarried children under the age of 23 who reside at home:

Yes |\/we have dependents as indicated below. “\___No I/we do not have dependents residing with us.
Name(s) Date of Birth Interests Charge
Privileges

[ / o Golf o Tennis o Yes o No
[ | o Golf o Tennis o Yes o No
/ i o Golf o Tennis o Yes o No

——S——— = See

Online Club Directory: Please indicate whether you wouid like to be listed in the Online Club Directory, and which
address and phone is to be listed: o Yes & No

Address: o Home Address o Local Address Phone: o Home Phone o Cell Phone

INTERESTS: Check all that apply _ PLEASE BILL ME FOR: Check all that apply

x] Men's Golf Association Men's Tennis | Men's Golf Locker ROSE
Ladies Golf Association Ladies Tennis | iy Ladies Golf Locker GOVERNMENT
Handicap Services | Ladies Cards | i = [| Men’s Club Storage EXHIBIT
| Fitness Center | Men's Cards || Ladies Club Storage
bation (es + - —— a 24-CR-80103-AMC
EXHIBIT y444
NO.
AR2205000734-0035 Page 1 of 6 MCCABE PGA RESORT APP
Case 9:24-cr-80103-AMC   Document 91-118   Entered on FLSD Docket 03/10/2025   Page 2 of 6
MEMBERSHIP INFORMATION: | am/We are applying for Membership in the following
Category: Mizar Gas aut ve FAMILY .X INDIVIDUAL
Total Joining Cost: =r? O7IS

Non-Refundable Portion** $ AYN (+ tax) + Refundable Portion™: $ a
Current Annual Dues**: $ Cary — (+ tax) °

Dues Prorated through October 31% $_ Y¢f0 _ (+tax)

**The combined total of the Non-Refundable Portion and Refundable Portion written above is the TOTAL actual amount
paid by Member (or if paying in installments, the total amount required to be paid by Member in accordance. with the terms
of Member's promissory note or installment payment agreement). Applicable sales tax, if any, not included.

PGA NATIONAL MEMBERS’ CLUB SPONSOR (PREFERRED)

NAME PHONE # EMAIL ADDRESS
PERSONAL REFERENCES 7
NAME EMAIL ADDRESS
( arly £1 4scher+
OTHER CLUB MEMERSHIPS
CLUB NAME CITY STATE

PAYMENT OF MEMBERSHIP ACCOUNT
Ve would prefer month atements to be mailed to: & Home e Business _o €-mail

Payment of Membership Account, including all dues, fees and other applicable charges, is due upon receipt of the monthly
statement. If accepted for membership, I/we agree to pay the account in full when due. I/We agree and understand that a
late charge up to the maximum amount allowable by law, or other penalties, may be assessed for past-due accounts as
provided for in the Bylaws and/or Rules and Regulations of the Club, as amended from time to time. In addition to late fees,
penalties may include, but are not limited to suspension of Club privileges and/or expulsion from membership. I/we agree
to maintain a valid major credit card on file with the Club at ail times. In the event that my/or account becomes more than
ninety (90) days past due, Club is hereby authorized to bill the card number on file. Payments on delinquent accounts shall
be applied first to reduce late charges, then to reduce accrued dues and food & beverage charges (with the payment applied
to reduce the oldest past due balances first), and then to any other charges. Any fees assessed for untimely payment of
any applicable dues, fees or charges will appear on my/our statement. I/We agree to pay all reasonable attorneys' fees,
investigator fees, and costs in the event this account is turned over for collection.

MEMBERSHIP POLICIES

if accepted into membership, I/we agree to conform to and be bound by the enrollment terms contained herein, the Bylaws,
the Rules and Regulations, and written membership policies of the Club (“Membership Documents”) as they may be
amended from time to time. /We further understand that agreeing to be bound by the Membership Documents is a part of
my/our agreement for membership privileges with the Club. We specifically understand this membership is not divisible
We hereby acknowledge receipt of a copy of the Bylaws and/or the Rules and Regulations of the Club.

WWE ACKNOWLEDGE THE MEMBERSHIP BYLAWS AND THE RULES AND REGULATIONS PROVIDE THE DETAILS
OF THE CLUB’S MEMBERSHIP POLICIES, CONDUCT AND OBLIGATIONS, INCLUDING, BUT NOT LIMITED TO,
PROVISIONS IN THE EVENT OF DIVORCE, FOR ARBITRATION OF DISPUTES, RESIGNATION, REDEMPTION OF
MEMBERSHIPS, FINANCIAL OBLIGATIONS, DISCIPLINARY ACTION, RELEASE OF LIABILITY FOR PERSONAL
INJURY AND THEFT. WWE HEREBY FULLY RELEASE AND DISCHARGE THE CLUB, !TS EMPLOYEES, AGENTS,
SHAREHOLDERS, MEMBERS, MANAGERS, AFFILIATES AND ASSIGNS FROM ANY LIABILITY, INJURY, LOSS,
DAMAGE OR CLAIM ARISING FROM MY/OUR USE OF THE CLUB FACILITIES.

AR2205000734-0035 Page 2 of 6 MCCABE PGA RESORT APPLICATION
Case 9:24-cr-80103-AMC   Document 91-118   Entered on FLSD Docket 03/10/2025   Page 3 of 6
i hereby acknowledge receipt of the Membership Plan and agree to be bound by the terms and conditions thereof as the
same may be amended from time to time by the Club in its discretion. | also understand that membership is on a non-
proprietary basis. | understand that membership may be terminated by the Club, in its sole discretion, for failure to abide
by membership conditions as set forth herein and in the Rules and Regulations. | hereby acknowledge that | have
reviewed the Rules and Regulations of the Club, specifically the following Sections of the Rules and Regulations
regarding my membership rights:

Article A Section 2 Charter Membership Rights

Article A Section 15 Suspensions and Termination of Membership

Article A Section 16 Loss or Destruction of Property

Article A Section 20 Acknowledgement of Membership Rights

By providing the address(es) (including e-mail), phone numbers(s), and fax number(s) above, I/we hereby give the Club
my/our express written permission to contact me/us at each number or address in accordance with the terms and conditions
of the Club’s Privacy Policy, a copy of which is available on the Club’s website. We acknowledge that the Club values
my/our right to privacy. I/We understand that I/we can revoke this consent at any time by contacting the Club in writing.

We agree the terms and conditions of my/our membership may not be added to, amended, or contradicted in any way by
evidence of prior, contemporaneous, or subsequent oral agreements of any kind and acknowledge there are no unwritten
oral agreements of any kind.

By signing below, we hereby certify that we hold a marriage license, or a certificate of domestic partnership or civil union,
which evidences our existing spousal relationship. If we do not hold one of the above, we acknowledge that the Club
requires execution of a separate Spousal Relationship Statement.

By signing the below, Lalso hereby agree and consent to allow representatives of the Ciub to photograph, film, tape

and/or record my likeness, voice, sound and quotations. | hereby arant to the Club and all related and affiliated entities
and their respective licensees and assigns. and the directors. officers emplovees and agents of each (collectively
“Released Parties"), forever and throughout the world, the right to use and license the right to reuse such photographs
films, tapes and/or recordings of my likeness. voice, sound, quotations, and my name, in all media, whether now known or
hereafter devised, throughout the universe in perpetuity, whether for advertising, publicity, or promotional purposes or for

any other purposes whatsoever.

We authorize Club to check my/our credit and employment history and to obtain such information as Club deems
necessary to accept my/our application and to extend credit to me/us under my/our membership account at the
Club. lwe understand and agree that 30-day written notification sent via certified mail, or e-mail to the General
Manager or idembership Director is required for resignation from the Club, and I/we further agree that all charges,
dues, and/or fees incurred during the 30-day period are valid debts.

Primary Candidate’s Signature Date
Spouse/Significant Other/Spousal Equivalent’s Signature Date 7
(Sea Ss Ee SSS SS

AR2205000734-0035 Page 3 of 6 MCCABE PGA RESORT APPLICATION
Case 9:24-cr-80103-AMC   Document 91-118   Entered on FLSD Docket 03/10/2025   Page 4 of 6
PGA NATIONAL MEMBERS CLUB DRESS CODE POLICY

The Dress Code Policy at PGA National Members Club has been established to preserve the club's ambience
as a respectable, family-oriented destination for intimate dinners, business functions and family gatherings. The
Committee wants all Members to feel comfortable and proud of their club.

Appropriate Country Club Casual Attire:

e Club appropriate blue or colored denim/blue jeans are permitted in all areas of the Members Club. The
host of a private event will determine if their guests may wear blue denim/blue jeans. Club appropriate
denim is defined as blue jean pants that are not tom, frayed, dirty or ill fitting. To be clear: not too fight,
too loose, in disrepair or adorned with words or pictures that may be offensive to others.

Golf, Croquet and Tennis athletic aitire.
Shorts, slacks, trousers, collared shirts or bandied collared shirts for men.

e Jackets for gentlemen are optional with exception of special events. Events requiring jackets will be
advertised as such.

« Shoes, sneakers, golf shoes.

* Appropriate blouses/fops or dresses are required for ladies.

Sundresses/or blouses with spaghetti straps are permitted, (cover ups are requested), provided that the
attire is in good taste and respectful of the Club and its Members.

Unacceptable Aftire:

Cotton/Athletic Style T-shirts.

Cutoffs, ripped or torn parts on clothes.

T-shirts with logos.

Sweat suits/bathing suits/swimming trunks.

Pool and beach footwear is not permitted. NO BEACH FLIP FLOPS.
Spandex or Lycra - such as biker shorts.

Midriff length tops - mid sections must be covered.

Hats/visors are not permitied for men indoors.

Tank tops for men.

in all areas, for all ages and both genders, excessively tight, short or baggy clothing is not considered
appropriate Country Club attire.

Cell Phones: Cell Phones MUST be PLACED ON SILENT or VIBRATE. NO cell phone conversations are permitted in
the Club Bar & Grille.

Smoking: The screened-in patio off the Member's Club Lounge and banquet room is a NO SMOKING area due
to Horida law. Smoking will be permitted downstairs outside of the front or side doors of the Club House.

Compliance: In order to safeguard the comfort of other Members and guests, dress code noncompliance can
result in refusal of admittance or service at the discretion of management on duty.

Review and Revision: Management aiong with the House and Events Committee and Board of Governors
reserve the right to rescind and/or amend this and all policies at any time.

Golf Course Attire

The following items are NOT permitted on the course or at practice facilities:

Denim of any color, tee shirts, tank tops, swimming attire, halter tops, running shorts, gym attire, snort shorts,
cargo shorts, worn or tattered clothing. This is noi acceptable golf aitire.

I/We have been informed about the Dress Code.

rat

Signature: {> PEL _ date: tf { LEA eo

AR2205000734-0035 Page 4 of 6 MCCABE PGA RESORT APPLICATION
Case 9:24-cr-80103-AMC   Document 91-118   Entered on FLSD Docket 03/10/2025   Page 5 of 6
AR2205000734-0035 Page 5 of 6 MCCABE PGA RESORT APPLICATION
Case 9:24-cr-80103-AMC   Document 91-118   Entered on FLSD Docket 03/10/2025   Page 6 of 6
Memberhip Sales office To Billina

Member number; Last name [he Laks YO G. o> -
Category by htc a &

me
Dues code 7 10} FA B
Sales Manager pyc L .
DUES 2020/2021

Dues Amount: xy G0 Tax Amount : i Oe Dues Total: Hod

Locker: ____ $ each tax: Club Storage: $ each tax:
Credit Amount; TOTAL PAYMENT:

Charge on CC: Check attached:

Comments:

INITIATION FEE

Amount: __< of) (OD Tax: ue Total: A oud.

Charge on CC; Check attached: 2 7) a vd

TOTAL PAID at Enrollment eA

PGA NATIONAL

AR2205000734-0035 Pas MCCABE PGA RESORT APP Af


File and source

File

gov.uscourts.flsd.673624.91.118.pdf

Size

1,610,282 bytes

SHA-256

bc51fb1e91e08a19636f6025f4e7f89f8563a43821a044918416a886a3902b20

Our copy

gov.uscourts.flsd.673624.91.118.pdf

Original

PACER (login required)