Application for Copper Membership

Seasonal Membership Applying For

Single or Family Membership

Family

Single

Membership Start Date

Membership End Date

Applicant’s Full Name *

Applicant’s Date of Birth

Address

Address

Address

Address

City

City

State/Province

State/Province

Zip/Postal

Zip/Postal

Country

Country

Home Phone Number

Cell Phone Number *

Email Address *

Okay to receive event/marketing information via email/text from Forty Niner Country Club?

YES

NO

Family Information

Spouse Name

Spouse Date of Birth

Child Name

Child Date of Birth

Child Name

Child Date of Birth

Child Name

Child Date of Birth

Child Name

Child Date of Birth

Sending