Brundidge Country Club Membership Application

Applicant Name

Enter the full name of the applicant.

This field is required.

Birthdate

This field is required.

Phone

Enter a valid phone number.

This field is required.

Spouse Name if Applicable

Enter the full name of the spouse.

This field is required.

Spouse Birthdate

This field is required.

Applicant Email

Enter a valid email address.

This field is required.

Current Address

Enter your current address.

This field is required.

How Long? (Current Address)

How long have you lived here?

This field is required.

City

Enter the city name.

This field is required.

State / ZIP

Enter your state and ZIP code.

This field is required.

Previous Address

Enter your previous address.

How Long? (Previous Address)

How long did you live there?

This field is required.

Applicant Employer

Enter the name of the applicant's employer.

This field is required.

Spouse Employer

Enter the name of the spouse's employer.

This field is required.

Occupation (Applicant)

Enter the applicant's occupation.

This field is required.

Occupation (Spouse)

Enter the spouse's occupation.

This field is required.

Employer Address (Applicant)

Enter the employer's address.

Employer Address (Spouse)

Enter the spouse's employer address.

Employer Phone (Applicant)

Enter the applicant's employer phone number.

This field is required.

Employer Phone (Spouse)

Enter the spouse's employer phone number.

This field is required.

Children Names and Birthdates

List children names along with their birthdates. Format: Name – Birthdate (mm/dd/yyyy)

Previous Club Memberships

List previous club memberships if any.

Bank Affiliation

Enter the name of your bank.

This field is required.

Credit References

Enter names and contact information for credit references.

Brundidge Country Club Sponsors

List any sponsors from the club if applicable.

Recreation Interests

Describe your recreational interests.

Have you ever been convicted of a felony?

Select Yes or No.

Yes

No

This field is required.

Applicant Certification Please check the box (to the left of Applicant) to certify that the information contained in this application is true and complete to the best of my knowledge. I understand that membership is subject to approval by the Brundidge Country Club Membership Committee and Board of Directors and agree to abide by the Club’s bylaws, rules, and policies.Public Law 91-508: Requires that we advise you that a routine inquiry may be made which will provide applicable information concerning credit history, character, general reputation, personal characteristics, and mode of living. Upon written request, additional information as to the nature and scope of the report, if one is made, will be provided.

This field is required.

Applicant Certification & Electronic SignaturePlease check the box (to the left of Applicant) to certify that all information provided in this membership application is true and complete to the best of my knowledge. I understand that Brundidge Country Club may verify the information provided. I also understand that submission of this application does not guarantee membership and that all applications are subject to review and approval by the Brundidge Country Club Membership Committee and Board of Directors.By checking this box and submitting this application, I acknowledge that my typed Applicant Name on this application serves as my electronic signature.

This field is required.