Membership Application

I wish to apply for a:

PERSONAL INFORMATION

Applicant Name
First Last

Applicant Birth Date

Applicant Mobile Number

Applicant E-mail Address

Spouse Name
First Last

Spouse Birth Date

Spouse E-mail Address

Residence Address
Street Address
Address Line 2

City State / Province / Region

Postal / Zip Code

Names and Birth Dates of children (under 23, unmarried and living at home)

Name
First Last
Birth Date
Name
First Last
Birth Date
Name
First Last
Birth Date
Name
First Last
Birth Date
Name
First Last
Birth Date
Name
First Last
Birth Date
Name
First Last
Birth Date
Name
First Last
Birth Date
BUISNESS INFORMATION/ APPLICANT

Name of Employer

Position

How long in this business (yrs)

Business Address
Street Address

Address Line 2

City State / Province

Postal / Zip Code

Phone

BUISNESS INFORMATION/ SPOUSE

Name of Employer

Position

How long in this business (yrs)

Business Address
Street Address

Address Line 2

City State / Province

Postal / Zip Code

Phone

OTHER INFORMATION
Please tell us what facilities are of primary interest to you and your family at the club.
Please send statements to:

Destination Address
Street Address
Address Line 2

City State / Province / Region

Postal / Zip Code

Please explain:
Sponsor Name
Full Name
Amenities
I would like to sign up for:
Men's Locker - ($90 anually)Women's Locker - ($90 anually)Club Storage - ($140 each set anually)Electronic Fund Transfer - (No charge)Annual Golf Cart Pass - ($650 plus tax anually)Men’s Association - ($75 anually)Men’s Handicap - ($30 anually)Women’s Association - ($20 anually)Ladies Handicap - ($30 anually)
Range Pass: (See rate sheet)
NoneIndividualJuniorSeniorCouplesFamily
Bill my dues:
AnnuallySemi-annuallyQuarterlyMonthly

I agree to abide by the rules and bylaws of the club.(The bylaws can be viewed by clicking here or you can request a copy from the office.)

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