Willow Bend Country Club Membership Application

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Types of Memberships
Application
Member Info
Committees
By-laws, Rules
& Regulations

Application For Membership
Full Name:
Street Address:
City:
State:
Your Birthdate:
Home Telephone Number:
Email Address:
Occupation:
Business Address:
Business Telephone Number:
Spouse's Name:
Spouse's Birthdate:
Wedding Anniversary:
First Participating Child's Name:
First Child's Birthdate:
Next Child's Name:
Next Child's Birthdate:
Next Child's Name:
Next Child's Birthdate:
Next Child's Name:
Next Child's Birthdate:
REFERENCES
List names of two or more members of the Willow Bend Country Club with whom you or your family are well acquainted:
Name:
Name:
If you have not listed at least two members above, then please give at least two personal references:
Name:
Address:
Name:
Address:
TYPE OF MEMBERSHIP 2008 Membership Dues
* Please check one box:	Family ($1,175.00 or $300.00 quarterly) Junior Family - under 35 years ($940.00 or $240.00 quarterly) Single - one golfer ($940.00 or $240.00 quarterly) Regional - live more than 35 miles from Van Wert ($500.00) Social - nongolfing ($250.00 or $65.00 quarterly) Business Social - nongolfing ($300.00 or $77.00 quarterly) Business Social - additional member ($40 per member) * Membership dues are subject to 7.0% sales tax.
Please check one box:	Annual payment of dues Quarterly payment of dues
I hereby submit application for membership in the Willow Bend Country Club. If membership is approved, I agree to be bound by the By-Laws, Rules, and Regulations of the Club now in effect or hereinafter adopted. *

* An application will be mailed so we can obtain your signature for our files.

Clubhouse: 419/238-0111 · restaurant@willow-bend.com · Fax: 419/238-2250
Pro Shop: 419/238-1041 · proshop@willow-bend.com