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                    Membership Application
 

Name___________________________________________________________________

Date of Birth_____________________________Phone___________________________

Home Address_____________________________________________________________

City_____________________________State_____________Zip___________________
 

Email___________________________________________________________________
 

Marital Status    Married___________     Single________________
 

Name of Spouse_________________________________Date of Birth_______________
(If applicable)
 

Children_________________________________________________________________
Children’s Birthdays_______________________________________________________
(All unmarried children living at home up to 25 years of age, full-time students or those in military service)

Name of Employer________________________________________________________
Position Held____________________________________________________________
Address__________________________________________ Phone_________________
City____________________________________State____________Zip_____________

Please mail monthly statements to my ____Home   _____Business

Type of Membership Desired ____Champions ____ Laurel    _____Affiliate (Single Only)

                                               _____Family       ____ Single    _____Corporate

Initiation Fee $________________   Monthly Dues $_________________________

Applicant acknowledges and agrees that by execution of this membership application and acceptance of this application by The Champions Club, applicant shall be bound by all the terms and conditions of the bylaws of The Champions Club as currently in effect and as may be amended from time to time.   The Champions Club assumes no responsibility for damages to persons, vehicles, homes or other property that may occur while using any club facilities or that a golfer may cause while playing golf.
 

Signature___________________________________________  Date_____________________________

Official Use Only______________________________

1111 Durbin Creek Blvd.   Jacksonville, Fl.   32259     (904) 287-4653    www.championsclubgolf.com