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Membership Application
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The Country Club of Winter Haven
Application for Membership
Title
Mrs.
Mr.
Ms.
Miss
Dr.
Applicant Name
Date of Birth
Title
Mr.
Mrs.
Ms.
Miss
Dr.
Spouse/Companion Name
Date of Birth
Primary Address
City
State
Zip
Secondary Address – if Applicable
City
State
Zip
Phone
Cell
Business/Alternate
Home/Other
Primary Email – Billing Statements/Club Info
Alternate Email – Club Info/Newsletters
Personal or Business References:
Name & Address
Phone
Name & Address
Phone
Club Affiliations (Past or Present):
Club Name and Address
Years you were a Member
Club Name and Address
Years you were a Member
Employment Information:
Company Name
Occupation
Address
City
State
Zip
Phone
Years of Service
Retired applicants, please list the company you retired from, position, and length of service.
Emergency Contact Information:
Name to contact in case of emergency
Phone
Name to contact in case of emergency
Phone
Family Information - Unmarried children under 25 living at home:
Name
Date of Birth
Name
Date of Birth
Name
Date of Birth
Name
Date of Birth
Membership Information:
Category of Membership
Individual, Family or Corporate Golf Membership
Date Membership Begins
Date Membership Ends
Signature of Applicant
Date
Signature of Spouse
Date
Membership is contingent on final approval by The Country Club of Winter Haven Board of Directors. You will be notified within ten days of the date of the date above if this application is denied for any reason.
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