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.

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* 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

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* 2. Title

Mrs

Other

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* 3. First Name

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* 4. Preferred Name

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* 5. Surname

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* 6. Date of birth

Your Date of Birth

Date

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* 7. Mobile Phone

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* 8. Home Phone

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* 9. E-mail Address

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* 10. Postal Address

Street Address

Street Address Line 2

City/Suburb

Postcode

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* 11. Residential Address (if different from above)

Street Address

Street Address Line 2

City/Suburb

Postcode

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* 12. Emergency Contact Details

Name

Phone

Relationship to applicant

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* 13. Do you hold an existing Golf Link Number?

Yes (please include Golf Link Number below)

Golf Link Number

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* 14. Do you want to make QGC your “Home Club” for handicap purposes?

Yes

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* 15. Have you ever been a member of the Queenscliff Golf Club before?

Yes

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* 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

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* 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.