Membership Application Form

APPLICANT INFORMATION
Company Name
Name*
First Last
Date of birth*
Month
Day
Year
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone*
Mobile Phone
Email*
Enter Email Confirm Email
SPOUSE INFORMATION
Spouse Name*
First Last
Spouse Date of birth*
Month
Day
Year
Address same as above?
- Yes
- No
Spouse Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone (if different from above)
Mobile Phone (if different from above)
Spouse Email (if different from above)
Enter Email Confirm Email

ADDITIONAL OPTIONS
Optional options
Additional Options
- $50 - RCGA Membership (Required for competitions)
- $100 - Personal locker
- $250 - Club storage and cleaning
- $100 - Personal three wheeled cart storage
Additional Options
- $100 - Personal three wheeled cart storage

Subtotal
Price: $ 0.00 CAD
HST
Price: $ 0.00 CAD
TOTAL
Price: $ 0.00 CAD
Child and/or Junior Members*
Name of immediate family member at club
First Last
TERMS OF AGREEMENT
1. Age considered as of Jan 1st of the playing season. Students must provide proof of full time enrollment in a recognized Center of Education.
2. By signing this form, I hereby allow the Cornwall Golf and Country Club to inset my personal information in its annual “Log book” and “members only” section on the website. The “Log book” is for the exclusive use of Cornwall Golf and Country Club members and staff and it is not to be shared with and/or distributed to any outside parties and/or agencies without the written authorization of the Directors of The Cornwall Golf and Country Club.
3. I hereby authorize my name for membership in the Cornwall Golf and Country Club Limited, and if approved, agree to become a member. I hereby subscribe to and agree to be governed by the By-Laws, Rules and Regulations of the said Club which are now in force or which may hereafter be enacted.
4. By signing this form, I hereby consent to receive our emails and other electronic communications.
Acknowledgement of Applicant*
- I agree
By checking this box and submitting this form I agree to the above statements.
Acknowledgement of Applicant Spouce*
- I, spouse of the applicant, agree
By checking this box and submitting this form I agree tot he above statements
Captcha
Please enter the characters you see in the image below.

APPLICANT INFORMATION