Mountain Grove Membership Application

Mountain Grove Membership Application
Date*

MonthDayYear
MEMBERSHIP NAME*
Membership Name (Last, First)
Name/Primary*

First NameLast Name
DOB*
Adult #1 Age
Name/Partner/Spouse

First NameLast Name
DOB
Adult #2 Age
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email/Primary*
Email/Partner/Spouse
Phone Number*

Area CodePhone Number
Child #1 Name & DOB
Child's Name & DOB
Child #2 Name & DOB
Child's Name & DOB
Child #3 Name & DOB
Child's Name & DOB
Child #4 Name & DOB
Child's Name & DOB
Child #5 Name & DOB
Child's Name & DOB
How did you hear about Mountain Grove?
Did someone recommend that you join Mountain Grove? If so – we’d love to know who so we can extend a thank you.
This application is subject to review and acceptance by the Board of Directors upon receipt of $20 Application Fee. LINK HERE to remit payment.

Applicants are responsible for informing Mountain Grove Club, Inc. of any change of address or phone number.

Please Note: When you become a member of Mountain Grove you become part of our member-owned facility. In addition to dues, all new members pay a refundable bond totaling $625 (please see bylaws for more information).
Signature*
Should be Empty: