Membership Candidate Information Statement

Membership in Other Clubs
Club Memberships
Sponsorship
Primary Member Sponsor*
First and Last Name(s)
Years Known
Secondary Member Sponsor
First and Last Name(s)
Years Known
Personal Reference*
First and Last Name(s) Personal references can be Members or Non-Members who, if asked, would provide a written recommendation on behalf of the Candidate.
Years Known
Additional Member References
Please list Member names
Statement of Intent
What is your ideal joining time?*
I understand that all communication shall be with the Sponsoring Member. The Club will not communicate directly with a Candidate. There is a high number of membership candidates who have been and continue to be proposed for membership. It is not an exaggeration to say it could be a number of years before your proposal is addressed.*

I understand

Authorization
Upon submission of this Prospective Member Information Statement, I authorize the disclosure and release of information requested by the Club for investigating my qualifications for membership, including without limitation, law enforcement records and obtaining credit report(s) reflecting my credit history, and shall hold the Club harmless from any and all such acts. I further authorize those persons or entities set forth in this statement to furnish all information requested by the Club and agree to hold the Club harmless from any and all such acts.*

I agree
I understand that membership in the Club is by invitation only and in order to acquire a membership in the Club, I must be invited for membership. Membership is contingent upon approval by the Club, which approval shall be at its discretion.*

I agree
All information contained within this Prospective Member Information Statement will be kept confidential by the Club except as otherwise required by law*

I agree
Candidate's Signature
Date*

MonthDayYear
Date
Please verify that you are not a robot*
Should be Empty:

Spouse/Significant Other Personal Information