Student Membership (under 18)

Parent' Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Student's Name

First Name

Last Name

Student Date of Birth

MM

DD

YYYY

Acceptance *

Cost of Membership Social membership for parents $ 60.00 Student membership 215.00 Tax 19.25 Total $294.25 All student memberships are subject to Board approval and payment in full is required with this form. Parents fill out the reverse side of this form.

By checking this form you (parent) are assuming responsibility for all charges, costs and other miscellaneous fees as a result of the student’s membership including club charges, cart, and course damage.