Experience Merced Golf & Country Club

Desired Membership Classification o Playing o Young Professional I (Ages 36-39)

o Young Professional III (Ages 26-29 o Young Professional IV (Ages 21-25)

o Firm - Playing o Firm - Designee

o Social

o Young Professional II (Ages 30-35)

Applicant Information Name Title

First

MI

Last

Home Address

Street

City

State

Zip Code

Primary Email Address

Date of Birth

Mobile Telephone Number

Social Security Number

Emergency Contact Name

Emergency Contact Number

Occupation and/or Nature of Business or Profession

o Retired

Name of Company

Title

Business Email Address

Business Phone Number

o Single o Married o Significant Other o Widowed

Anniversary Date

Spouse / Domestic Partner / Significant Other Information Name Title First MI Last

Primary Email Address

Date of Birth

Mobile Telephone Number

Social Security Number

Occupation and/or Nature of Business or Profession

o Retired

Name of Company

Title

Business Email Address

Business Phone Number

Dependent Information Please list any children ages 20 or full-time students up to age 24. Proof of age may be required. 1. Name Age DOB

Golf Privileges o Yes o No

2. Name

Age

DOB

Golf Privileges o Yes o No

3. Name

Age

DOB

Golf Privileges o Yes o No

4. Name

Age

DOB

Golf Privileges o Yes o No