Full Membership Application Form

Title*

MrMissMrsMsOther
Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Email*
example@example.com
Mobile Number*
Address*

Street Address

SuburbState

Post Code
Occupation/Formal Qualifications*
Company*
Emergency Contact Name*
Emergency Contact Number*
Please tick which category you are applying for:

7 day - 7 day playing rights6 day - Excludes SaturdaysYounger Member - 7 day Aged 21-25Younger Member - 7 day Aged 26-29Younger Member - 6 day Aged 21-25Younger Member - 6 day Aged 26-29Member Under 21 - 18-20 years or full time students under 25 years - 7 day playing rightsJunior (aged 12-17) - 7 day playing rightsCadet (aged 8-11) - 6 day playing rightsCountry - must reside 100kms radius from the clubhouse - 7 day playing rights
For under 18's, parents/guardians are required to complete the following:*

I will receive all correspondence from the Club, not the childI am responsible for payment of all accountsI give consent to using child's name and image including photography for general marketing and promotion activitiesI authorise the Club to make such arrangements as deemed necessary in the event of an emergencyI accept all terms and conditions relating to membership on behalf of the child
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Phone Number*
Parent/Guardian Email*
example@example.com
Signature of Parent/Guardian*

Clear
If applicable, could you please provide your Golf Link Number?
Are you currently or have you previously been a member of another club? If so, could you kindly provide the name of the club?
Golf Experience*

I am new to golfI am a novice golfer (under 2 years experience)I am an experienced golfer
Do you know any current members at Kooringal Golf Club? If so, could you kindly provide their names?

PROPOSER SECONDER
Agree to the terms and conditions of joining Kooringal Golf Club*

If elected to membership, I agree I am bound by the Club’s Constitution and accept all terms and conditions of being a member of Kooringal Golf Club, including its rules and policies.I agree to have my name, phone number and email address displayed in the members directory, which can only be used for organising golf or social activities amongst members. In addition, I allow the Club to use my contact details to send me golf club related newsletters and information.
Signature of Candidate*

Clear
How did you hear about us?*

Club WebsiteWord of MouthFacebookInstagramI'm a Returning MemberGoogleLive LocalOther
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