Membership Application

Worthington Golf Club

Ridge Road

Worthington, MA 01098

                                                                                    Member #____________

Date:______________     

 

Type of Membership:  ____Family ____Couple ____Individual ____Young Adult ____Senior

                                                                                ____ Junior  ____Porch

Applicant’s Name in Full:______________________________________________________

Residence Address:__________________________________________________________

            City/Town: _____________________________Zip__________Telephone__________________

 

Business or Profession:__________________________________________________________________

Firm Name:______________________________________________________________            _____________

Business Address:______________________________________________________________________

                City/Town_____________________________________________________________________

Mailing Address:_______________________________________________________________________

 

Names Of Other Golf Clubs Of Which You Are A Member: _______________________________

_______________________________________________________________________

_______________________________________________________________________

Golf Handicap:___________

 

Names of Immediate Family (for Club’s Records):

 

NAME                                                                   RELATIONSHIP                                                  AGE

_________________________          _________________________          ____________

_________________________          _________________________          ____________

_________________________          _________________________          ____________

_________________________          _________________________          ____________

 

Signature of Applicant:________________________________________________________

 

Do Not Write Below This Line

________________________________________________________________________

Signature of Proposers (1)_________________________________________________________________

                                         (2)_________________________________________________________________

Approved By Membership Committee/Chr._____________________________ Date:__________________

 

Elected By Board of Directors/Secy____________________________________Date:_________________

 

First Year’s Dues and Stock Received/Treas_____________________________Date:_________________

 

Applicant Notified/Secy_____________________________________________Date:_________________

 

Stock Certificate Issued/Treas________________________________________Date:_________________

 

Note:  Remittance covering payment in full for stock and first year’s dues MUST accompany this application.                                                                                                                                                                               Rev 03/00

 

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