Rupert Country Club Membership
Please provide updated contact information
Corporate Membership - Business Name (If Applicable)
Total family members under membership INCLUDING Main Member
*
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Main Member
*
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Gender
Male
Female
Plays Golf?
Yes
No
Email
*
example@example.com
Phone Number
-
Area Code
Phone Number
Member 2
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Relation to Main Member
Spouse
Child
Other
Gender
Male
Female
Plays Golf?
Yes
No
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Member 3
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Relation to Main Member
Spouse
Child
Other
Gender
Male
Female
Plays Golf?
Yes
No
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Member 4
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Relation to Main Member
Spouse
Child
Other
Gender
Male
Female
Plays Golf?
Yes
No
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Member 5
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Relation to Main Member
Spouse
Child
Other
Gender
Male
Female
Plays Golf?
Yes
No
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Member 6
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Relation to Main Member
Spouse
Child
Other
Gender
Male
Female
Plays Golf?
Yes
No
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Member 7
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Relation to Main Member
Spouse
Child
Other
Gender
Male
Female
Plays Golf?
Yes
No
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Member 8
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Relation to Main Member
Spouse
Child
Other
Gender
Male
Female
Plays Golf?
Yes
No
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Member 9
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Relation to Main Member
Spouse
Child
Other
Gender
Male
Female
Plays Golf?
Yes
No
Phone Number
-
Area Code
Phone Number
Email
example@example.com
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