Laverne Golf & Country Club

                                                         Membership Application

 

 

 Primary Member’s Name: __________________________

Address: ________________________________________

City: _________________ State:______ Zip: ___________

Birth date :( mo/day/year) ________________

Home phone :(_____)__________Email:_______________

 

 

 

 

Payment Information

□ Annual Membership                     $420.00

 

Payment Options:

Monthly                                            $35.00

Cart Shed                                          $20.00

 

** (Monthly payments by bank draft only at Bank of Laverne) **

** If not drafting you can write a check, Payment due quarterly, every six months or in full annually

 

                               

  Please List additional family name(s) that will be on the membership:

     

 Name:                                                                                  Relationship:

______________________________________________                  ______________

______________________________________________                  ______________

______________________________________________                  ______________

 

     

                                     Total Amount Enclosed ____________ 

 

     Please put Application in green box or take to David Terry’s CPA office

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