Queenscliff Golf Club Membership Application Form 2020 Membership Year All our memberships run from March 1. Pro Rata is available. For more information on membership types, visit our website. Question Title * 1. Please indicate the membership type*: Full Member - $1250 Junior Member - $160 Country Member - $965 Lifestyle Core - $785 Lifestyle Social - $265 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 By submitting this form I agree to abide by the Constitution and By Laws of Queenscliff Golf Club.All payments include GST.PAYMENT(If selected Remote Credit Card Deduction) I permit the Queenscliff Golf Club to deduct the amount, listed next to my selected membership type above, for my initial membership fee using the following credit card details: Question Title * 17. Credit card details: Type of card (Visa/MC only) Name on card Card number Expiry (MM/YY) DONE!