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.

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* 1. Please indicate the membership type*:

Full Member - $1250

Junior Member - $160

Country Member - $965

Lifestyle Core - $785

Lifestyle Social - $265

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

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:

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* 17. Credit card details:

Type of card (Visa/MC only)

Name on card

Card number

Expiry (MM/YY)