First & Last Name

Address

City

State

Zip

Home Phone

Email

Business Name

Business Phone

Spouse Name

Age(s) of Child(ren)

Do you golf? Do you golf? Yes No

Does your spouse golf? Does your spouse golf? Yes No

Are either you or your spouse over the age of 35? Are either you or your spouse over the age of 35? Yes No

What type of membership are you interested in? What type of membership are you interested in?ResidentNon-ResidentJuniorCorporate

Please list current members you know