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

Photo ID*

Please upload a copy of your photo ID

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 Charged Details

NAR

Debtor Number

Full Membership	$550
Full Membership (New Member Discount)	$340
Full Membership (Age 18 - 29)	$275
Pensioner Membership	$450
Sports Golfer	$290
Junior Membership	$82