Experience Wampanoag Country Club

Dependents Unmarried Children of applicant under the age of 26.

o Female o Male

Name

Age

Date of Birth

o Female o Male

Name

Age

Date of Birth

o Female o Male

Name

Age

Date of Birth

o Female o Male

Name

Age

Date of Birth

Terms of Membership I submit with this application $

check made payable to Wampanoag Country Club, Inc. as full/partial payment of the required non-refundable initiation fee for the above mentioned membership. The remaining balance in the amount of $ will be due on . 1. Approval for Membership I understand that this application will not be acted upon unless fully completed, signed and accompanied by the requisite initiation fee. Membership is contingent upon the approval by the Club in the Club’s sole and absolute discretion. It is agreed that if this application is not acted upon favorably, the initiation fee check shall be promptly returned or refunded and this Agreement shall terminate. It is the policy of the Club to not discriminate in any manner

against any application. 2. Receipt of By-Laws

My/our signature(s) below shall acknowledge receipt of the By-Laws and Rules and Procedures and agree to be bound by the terms and conditions thereof, as the same are

amended from time to time. 3. Verification of Application

By signing this application, I authorize the disclosure and release of information to the Club for investigating my qualifications for membership and authorize those persons or entities listed herein to furnish information to the Club. If the applicant is married, the signature of the applicant’s spouse is required. Date: Applicant Signature: Date: Spouse Signature:

4. Approved and Accepted (For office Use Only) By:

Sponsor:

Date:

Sponsor Credit (if applicable): $