BEN Franklin golf club Membership Application
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Applicant Information (Fields with *Required Information) |
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Name:* |
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Date of birth:* |
Phone:* |
Fax: |
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Current address:* |
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City:* |
State:* |
ZIP Code:* |
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E-mail: |
Fax: |
NCGA # (if existing): |
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Employment Information |
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Current employer: |
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Employer address: |
How long? |
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Phone: |
E-mail: |
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City: |
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Position: |
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Emergency Contact |
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Name of a relative not residing with you: |
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Address: |
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City: |
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ZIP Code: |
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Relationship: |
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Spouse Information if joint membership |
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Name: |
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Date of birth: |
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Phone: |
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Spouse Employment Information |
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Current employer: |
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Employer address: |
How long? |
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Phone: |
E-mail: |
Fax: |
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City: |
State: |
ZIP Code: |
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Position: |
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Yearly membership Due december 1st each year |
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New Adult
Member*
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New Youth Member (Under18)* |
Returning
Member*
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$50.00 |
$21.00 |
$40.00 |
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Number of
Members -* |
Number of Members -* |
Number of Members -* |
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Children if membership privileges desired |
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Name * Age* |
Name * Age* |
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Name * Age* |
Name * Age* |
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Signatures |
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I authorize the verification of the information provided on this form. |
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Signature of applicant:* |
Date:* |
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Signature of spouse (only if for a joint membership): |
Date: |
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Mail Completed Application To: Ron Arnall 12868 Digger