APPLICATION FOR MEMBERSHIP Primary Name (required) Spouse’s Name Local Address City State Zip Northern Address: City State Zip Local Phone # Primary Cell # Northern Phone # Spouse’s Cell # Primary Email (required) Spouse Email Circle Status: SingleDivorcedWidow (er)Married Primary Date of Birth Spouses Date of Birth Primary Place of Birth Spouse’s Place of Birth Unmarried Children of Applicant under age of 24 living at home or attending school full-time: Name Date of Birth Name Date of Birth Name Date of Birth EMPLOYMENT INFORMATIONPrimary Applicant Occupation Employer Employer Address Work Phone Years in Employment Spouse’s Occupation Employer Employer Address Work Phone Years in Employment REFERENCESName Phone # Years Known Name Phone # Years Known CURRENT AND PREVIOUS COUNTRY CLUB AFFILIATIONSName City State Zip Name City State Zip Please indicate the category of membership desired by placing a check in the appropriate box below: Full Membership SportsMembership LifestyleMembership SocialMembership Upon signing this Application for Membership Priveleges, I authorize the disclosure and release of information to Vineyards Country Club, Inc. for investigating my qualifications for membership and authorize those persons or entities herein to furnish information to Vineyards Country Club, Inc.I understand that acceptance for membership in Vineyards Country Club, Inc. is subject to approval by Vineyards Country Club, Inc. and payment of the required membership contribution, dues and charges.Primary Signature Date Spouse’s Signature Date
