Queenscliff Golf Club Membership Application Form 2021 Membership Year All our memberships run from March 1. Pro Rata is available. Prices include GST.For more information on membership types, visit our website. Question Title * 1. Please indicate the membership type*: Full Member - $1325 Junior U21 Member - $170 Age 21-25 - $350 Age 25-30 - $800 Lifestyle Core - $825 Lifestyle Social - $280 New Ladies Package (First Year) - $875 Couple Initiative - $2200 *please sign up separately and leave a note about who you're signing up with in Q16 Social - $55 Question Title * 2. Title Mr Mrs Ms Other Question Title * 3. First Name Question Title * 4. Preferred Name Question Title * 5. Surname Question Title * 6. Date of birth Your Date of Birth Date Question Title * 7. Mobile Phone Question Title * 8. Home Phone Question Title * 9. E-mail Address Question Title * 10. Postal Address Street Address Street Address Line 2 City/Suburb Postcode Question Title * 11. Residential Address (if different from above) Street Address Street Address Line 2 City/Suburb Postcode Question Title * 12. Emergency Contact Details Name Phone Relationship to applicant Question Title * 13. Do you hold an existing Golf Link Number? Yes (please include Golf Link Number below) No Golf Link Number Question Title * 14. Do you want to make QGC your “Home Club” for handicap purposes? Yes No Question Title * 15. Have you ever been a member of the Queenscliff Golf Club before? Yes No Question Title * 16. Please select your desired payment method: In Club *Note: We will not process your membership until payment has been received Credit Card Remotely (Below) Please Contact Me - include method of contact in comments Comments Question Title * 17. Credit card details: Type of card (Visa/MC only) Name on card Card number Expiry (MM/YY) If you have selected 'Credit Card Remotely', you have given Queenscliff Golf Club permission to deduct the amount, listed next to your selected membership type above, for your initial membership fee using the card details above. By submitting this form I agree to abide by the Constitution and By Laws of Queenscliff Golf Club. DONE!