Membership Type:

Monthly Dues:___________________________

Name:_____________________________D.O.B:_____________________
Address:_________________________________City:_________________
State: ____________________________________Zip:_________________
Phone: __________________Alternate Phone: ________________________
Email: ________________________________S.S. #______-______-______

Company: _________________________Position_____________________
Company Address: __________________Phone:______________________
City: _________________State:_____________Zip:___________________

Spouse Information
Name:_____________________________D.O.B._____________________
Email:_____________________________S.S. #______-_______-________
Alternate Phone:_____________________

Dependent Information
Name:_______________________________D.O.B._________________
Name:_______________________________D.O.B._________________
Name:_______________________________D.O.B._________________
Name:_______________________________D.O.B._________________

Financial Information

Name of Bank:_____________________Account #:__________________
Major Credit Card Type:___________ Account #____________________
Exp Date:_______________
Signature:______________________ Date:_________________________
Signature of Spouse:____________________________Date:____________

Did you have a current member recommend you? If so, please list below:
____________________________________________________________

I hereby agree to abide by the rules prescribed by the management of the Foxcliff Board of Directors and the Golf Professional and his staff. I further agree to pay all dues, fees and all other charges incurred by me, my spouse, children and guests. I also understand that my in-house account charge privileges may be suspended or revoked for non-payment and that my membership may also be suspended or terminated for non-payment. I also agree to pay court costs and expenses and reasonable attorney fees should the Foxcliff Golf Club, Inc. seek legal remedy for non payment of dues, fees and any other charges incurred by me, my family and my guests. I also agree that my membership is for twelve (12) consecutive months and agree to the monthly dues as set forth above.

Member Signature:___________________________________Date:________________
Spouses Signature:___________________________________Date:________________

Office use only
Account # Assigned:___________ Payment Method:______________Check#_______
Application taken by:_________________Date:___________

* Prepayment of dues or fees are non-refundable.