Experience The Country Club of Harrisburg

Affiliations Are you a prior Member of The Country Club of Harrisburg? o Yes o No

If so, when?

Are you a current or previous Member of another Country Club? o Yes o No

If yes, please list below:

1. Name

City

Type (Golf, Social, etc.)

From

to

2. Name

City

Type (Golf, Social, etc.)

From

to

Member Sponsors Name

Years Known

Signature

Name

Years Known

Signature

Photo Release I agree to grant Country Club of Harrisburg, its representative and employees the right to take photographs of me and my family members. I further agree that any or all of the material photographed may be used, in any form, as part of any future publications, brochure, or other printed materials, website, digital communications, and/or social media used to promote Country Club of Harrisburg, and further that such use shall be without payment of fees, royalties, special credit or other compensation. o Yes o No Authorization By signing this Membership Application for The Country Club of Harrisburg, I hereby authorize The Country Club of Harrisburg, through its representatives, to make inquiry of my financial condition, our family and professional background and specifically authorize them to make inquiry of consumer credit reporting organizations. The undersigned does hereby acknowledge, accept and understand that I have truthfully and to the best of my ability answered all application questions. If my Membership Application is granted, I agree to observe and be bound by the Bylaws and Rules and Regulations of The Country Club of Harrisburg in the present form or as may be amended. I acknowledge, accept and understand that I am personally liable and responsible for all financial obligations relating to my membership and any of my family members who will be utilizing The Country Club of Harrisburg.

Signature of Applicant

Date

Signature of Spouse/Significant Other

Date