Membership ApplicationNAME:____________________________________ 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:______________________________________________________ |