Membership Application

NAME:____________________________________  GENDER:___________

STREET ADDRESS:______________________________________________

CITY:________________  PROVINCE:_____  POSTAL CODE:___________

PHONE:  HOME____________  OFFICE____________  BIRTH:__________

DOCTOR'S NAME:_____________________  CLINIC #:________________

EMERGENCY CONTACT:_________________________________________

MEDICATION ALLERGIES:________________________________________

PERMISSION TO CALL AN AMBULANCE:_______________________(sign)

WAIVER

"I AGREE TO ABIDE BY WHATEVER RULES AND REGULATIONS, WHICH FROM TIME TO TIME MAY BE DEEMED NECESSARY BY THE MANAGEMENT.

MANAGEMENT TAKES NO RESPONSIBILITY FOR INJURY TO MEMBERS CAUSED BY ANY VIOLATIONS OF THE EXPRESSED RULES AND REGULATIONS.

I UNDERSTAND THAT FAILURE TO ABIDE BY THE RULES OF ARDMORE GOLF COURSE LTD MAY RESULT IN CANCELLATION OF MY GOLF MEMBERSHIP."

SIGNATURE OF APPLICANT:_____________________________________

STAFF WITNESS (SIGNATURE):___________________________________

TODAY'S DATE:_____________________  JOIN DATE:_________________


TYPE OF MEMBERSHIP (circle one)

SEVEN DAY                FIVE DAY                AFTER 3                JUNIOR

ENTRANCE FEE: $__________________  GST: $_______________

MEMBERSHIP DUES: $______________  GST: $_______________

TOTAL PAYMENT: $____________________

DETAILS:______________________________________________________