Membership Application

MEMBER :

First Name : *

Middle Initial :

Last Name : *

Prefix :

Suffix :

Legacy Member - Parent’s Name :

Principal Residence:

Street : *

City : *

State : *

Zip : *

Home : *

Cell : *

SS #

E-Mail Address : *

Date of Birth : *

Winter Residence: If Applicable

BUSINESS:

Company : *

Title :

Telephone : *

Street : *

City : *

State : *

Zip : *

SPOUSE:

First Name :

Middle Initial :

Last Name :

Prefix :

Suffix :

Wedding Anniversary :

Cell :

Date of Birth :

E-Mail Address :

SINGLE CHILDREN :

Name :

Date of Birth :

Name :

Date of Birth :

Name :

Date of Birth :

Name :

Date of Birth :

Name :

Date of Birth :

Name :

Date of Birth :

Age 21 or Younger Living at Home and/or Age 24 or Younger Attending College on a Full Time Basis

Mailing Preferences:

Billing Address : *

Business

Residence

Mail address :

Club Mailings : *

Business

Residence

Mail address :

PERSONAL REFERENCES:

Name : *

Address : *

Telephone : *

Name :

Address :

Telephone :

EXISTING CLUB MEMBERSHIPS, IF AVAILABLE:

Name :

Address :

Telephone :

Class of Membership :

Years of Membership :

Social Plus Membership Information:

Child’s Name :

Age :

Golfing Months :

Child’s Name :

Age :

Golfing Months :

Child’s Name :

Age :

Golfing Months :

Applicant’s Signature :

Date

Parent/Guardian Signature, if applicable :

Date

By signing the Huntsville Golf Club Membership Application, the Applicant and his/her spouse or designated user (if applicable) listed therein, agree to abide by the terms and conditions of the Huntsville Golf Club Constitution if their application for membership is accepted.
Huntsville Golf Club does not discriminate against applicants for membership because of age, gender, religion, race or national origin.

Please send form to:
Bridget Occhiato, Membership Director, Huntsville Golf Club, 1334 Market Street, Dallas, PA 18612

For Office Use Only

HGC Member Number:

Additional Information:

	Clergy
	Corporate
	Junior*
	Legacy Junior
	Legacy Young Professional
	Non-Resident
	Regular
	School of Golf
	Social
	Social Plus
	Young Professional