Irene Country Club Membership Application 2026

Membership Sport Type

Membership Category

Title

Surname

Name(s)

Date of Birth

Date

ID Number

Gender

Residential Address

Postal Code

Occupation

Employer

Nature of Business

Cell Number

Please enter a valid phone number.Format: (000) 000-0000.

Alternative Number

Please enter a valid phone number.Format: (000) 000-0000.

Email Address

example@example.com

Spouse/Next of Kin Name & Surname

First NameLast Name

Relation to Member

Spouse/Next of Kin Cell Number

Please enter a valid phone number.Format: (000) 000-0000.

Spouse / Next of Kin Email

example@example.com

Name of Previous Club

Have you been a member of ICC before?

Who introduced you to Irene Country Club?

Signature Date

Date

Applicant Signature

By signing, I acknowledge and agree to abide by the Rules and Regulations of the Irene Country Club Constitution and confirm that I have read and understood the Permission, Code of Conduct and Disclaimer Form contained on page 2 of this document.

Guardian Name (If Applicant is a Minor)

Capacity (If Applicant is a Minor)

Guardian Signature (If Applicant is a Minor)

By signing, I acknowledge and agree to abide by the Rules and Regulations of the Irene Country Club Constitution and confirm that I have read and understood the Permission, Code of Conduct and Disclaimer Form contained on page 2 of this document.

Approved By

Approval Signature

Irene Country Club Membership Application

Details of Applicant

Contact and Personal Information

Details of Spouse / Next of Kin (In Case of Emergency)

Membership of Previous Club

Declarations and Signatures

Office Use Only