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Maccripine Membership Application |
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APPLICATION FOR MEMBERSHIP
APPLICANT INFORMATION - ALL BLANKS MUST BE FILLED IN (PLEASE PRINT)
1. _____________________________________ ____________________________________________ FULL NAME OF APPLICANT SPOUSE'S NAME
2. MAILING ADDRESS_________________________________________________________________ ______________________________Phone #___________________Cell #_______________________
PRINT E-Mail Address: ___________________________________________________________
3. Applicant's Date of Birth____________________________________________________________ 4. Name of Employer ___________________________________________Phone_________________ 5. Spouse's Employer ___________________________________________Phone_________________ 6. Names & Ages of Children Eligible to Use Club _____________________________________ ______________________________________
7. Other Country Clubs Applicant Belongs To or Is Affiliated With: ______________________________________________
8. SIGNATURE OF SPONSORING Maccripine member
_________________________________________________________________________________ NAME PHONE
9. APPLICANT SIGNATURE________________________________________________________
Please return completed application to the club office, MACCRIPINE COUNTRY CLUB, P.O. Box 85, Pinetops, N.C. 27864. Please send a check for the first month’s dues of $_______with this application
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AUTHORIZATION FOR BANK DRAFT OF DUES Bank Name:________________________________________________________________________________________ City:________________________________________________State:_______________________ZIP:________________ ABA Transit/Routing Number (9digits):___________________________________________________________________ Bank Account Number:_______________________________________________________________________________ Circle Account Type: Checking or Savings Applicant’s signature will authorize an electronic draft of dues between the 1st & 10th of each month unless he/she sends notice to cancel membership.
________________________________________ ___________________________________ SIGNATURE DATE |
