Membership Registration Form

MEMBER INFORMATION

Date:

Last Name	First Name:	MI:
Address	City
State	Zip
Length of Residence
Home Phone	Home Fax
Email Address
Date of Birth

BUSINESS INFORMATION

Company	Position
Length of Employment
Business Address	City
State	Zip
Phone	Fax
Email
Previous Company	Position
Length of Employment

SPOUSE INFORMATION

Last Name	First Name:	MI:
Date of Birth

SPOUSE BUSINESS INFORMATION

Company	Position
Length of Employment
Business Address	City
State	Zip
Phone	Fax
Email

REFERENCES (Please list three (3) current Ridgeway Country Club Members only.
Name
Name
Name

CLUB AFFILIATIONS
(Please list all Private, Fraternal, or Civic Club Memberships you have held/ presently hold.)

Name	Address
Name	Address
Name	Address

DEPENDENT INFORMATION (Please list all children under the age of 21.)
Name	Date of Birth
Name	Date of Birth
Name	Date of Birth
Name	Date of Birth
Name	Date of Birth
Name	Date of Birth

CONTACT REFERENCES
Send all statement notices to:		Home Address
Send all statement notices to:		Business Address

Send all social and club correspondence to:		Home Address
Send all social and club correspondence to:		Business Address

MEMBERSHIP CLASSIFICATION
Payments must be submitted with application. Please make checks payable to Ridgeway Country Club.

Category	Initiation Fee
Total Amt. of Check

AGREEMENT

The undersigned hereby applies for membership in the Ridgeway Country Club and agrees to remain a member for a period of not less than twelve (12) months, transfers out of the area excepted. It is further understood that Club privileges shall not begin until this application is approved by the Ridgeway Country Club Board of Directors. Furthermore, the undersigned hereby agrees to pay for all dues, assessments, and/or charges for food and service costs within 30 days, and further agrees to pay all costs, including reasonable attorney fees and expenses, and court costs incurred in the cost of the indebtedness. BY-LAWS It is understood that if I do not comply with the By-Laws of the Ridgeway Country Club Corporation and the Rules and regulations promulgated by the Director and different committees effective at present and in the future, I will be subject to suspension or expulsion by the Board of Directors.

AUTHORIZATION AND RELEASE INFORMATION

I hereby authorize and request any law enforcement agency, financial institution, or other person having personal knowledge about me to furnish Data Facts, Inc. any and all information in their possession regarding me, in connection with an application for membership with Ridgeway Country Club. I understand and offer my consent for Data Facts, Inc. to inquire into and/or obtain any records such as credit and criminal histories. My signature on this form waives any rights I may have to bring action for defamation, invasion of privacy, or similar causes against Data Facts, Inc., and/or agents or clients of Data Facts, Inc. I am willing that a photocopy of this authorization be accepted with the same authority as the original.

Applicant Full Name
Maiden Name
Former Married Name
Date of Change
Date of Birth

Current Address	City
State	Zip
Length of Residence	County

Previous Address	City
State	Zip
Length of Residence	County

Previous Address	City
State	Zip
Length of Residence	County

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