Golf Course Membership Application

Name*

Prefix First Middle Initial Last

Residential Address*

Street Address City State Postcode Country

Postal Address*

Same as residential

Street Address City State Postcode Country

Phone*

Email*

Occupation*

Left or Right Handed*

Left

Right

Ambidextrous

Date of birth*

Current Golf Course

Golflink Number

Emergency Contact

First Last

Phone

Relationship

Pension Card Upload*

Please upload a copy of your pension card

I, , wish to join the Leeton Golf Course and hereby apply to be admitted as a member thereof and agree to be subject to the Rules and Regulations governing the course.

Signature

Submission Date

Would like a copy of this application sent to you email?

Yes

Credit Card

Card Details

Cardholder Name

Total to be charged to credit card

Comments

This field is for validation purposes and should be left unchanged.

Full Membership	$520
Full Membership (New Member Discount)	$320
Full Membership (Age 18 - 29)	$260
Pensioner Membership	$425
Sports Golfer	$275
Junior Membership	$75