Membership Application Form

Salutation (please select one):

Mr.Mrs.Ms.Dr.

Name:*

First NameLast Name

Date of Birth:*

Date

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Residence:

OwnRent

Mobile Phone:*

Work Phone:

E-mail (Primary):*

example@example.com

E-mail (Secondary):

example@example.com

Marital Status:*

SingleMarried

Employer:*

Position/Title:

Employer Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Years Employed:

Work Phone:

Please enter a valid phone number.

Mobile Phone:

Please enter a valid phone number.

Email (Work):

example@example.com

Spouse's Name:*

First NameLast Name

Date of Birth:

Date

Spouse's Employer:*

Position/Title:

Children's Information (Unmarried children under 25 years of age living at home or attending school on a full time basis):

First NameLast Name

Child's Age:

Gender:

MaleFemale

Children's Information (Unmarried children under 25 years of age living at home or attending school on a full-time basis):

First NameLast Name

Child's Age:

Gender:

MaleFemale

Children's Information (Unmarried children under 25 years of age living at home or attending school on a full-time basis):

First NameLast Name

Child's Age:

Gender:

MaleFemale

Children's Information (Unmarried children under 25 years of age living at home or attending school on a full-time basis):

First NameLast Name

Child's Age:

Gender:

MaleFemale

Membership Category Applied For (Check One):*

Resident MemberDues: $230/monthly. Resident Members are entitled to the use of all the golf, swimming, and dining/social facilities of the Club. A food and beverage minimum ($50) is required for this type of membership. Resident Members do not pay green fees when using the golf facilities.

$230.00

Resident Social MemberDues: $165/monthly. Resident Social Members are entitled to the use of all the swimming and dining/social facilities of the Club. A food and beverage minimum ($50) is required for this type of membership. Resident Social Members are required to pay green fees when using the golf facilities.

$165.00

Junior MemberDues: $160/monthly. Junior Members are entitled to the use all of the golf, swimming, and dining/social facilities of the Club. Both the primary member and spouse must be under the age of 30 when applying for membership. An upgrade of the membership is required upon the 30th birthday of the primary member. A food and beverage minimum ($50) is required for this type of membership. Junior Members do not pay green fees when using the golf facilities.

$160.00

Widowed MemberDues: $115/monthly. Widowed Members are entitled to the use of all the golf, swimming, and dining/social facilities of the Club. A food and beverage minimum ($50) is required for this type of membership. Widowed Members do not pay green fees when using the golf facilities.

$115.00

Intermediate MemberDues: $175/monthly. Intermediate Members are members that reside primarily within a 25 – 100-mile radius from the Club and are entitled to the use all of the golf, swimming, and dining/social facilities of the Club. A food and beverage minimum ($50) is required for this type of membership. Intermediate Members do not pay green fees when using the golf facilities.

$175.00

Out-of-Town MemberDues: $65/monthly. Out-of-Town Members are members that reside primarily outside of a 100-mile radius from the Club and are entitled to the use all of the golf, swimming, and dining/social facilities of the Club. A food and beverage minimum is not required for this type of membership. Out-of-Town Members do not pay green fees when using the golf facilities.

$65.00

Total

$0.00

Sponsor's Name:*

First NameLast Name

Co-Sponsor's Name:

First NameLast Name

Billing Address:

Use the address above.I want to specify a different billing address.

Billing Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please Type Name:*

First NameLast Name

Signature:*

Date of Signature:*

Date

Membership Application

Primary Member Information

Business/Professional Information

Family Information

Membership Information

Sponsor Information

Payment Terms

Membership Agreement