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REEDSBURG COUNTRY CLUB APPLICATION  FOR  MEMBERSHIP  

I hereby make an application for a ___________________  (Membership Type) membership in the Reedsburg Country Club and agree to abide by all rules, regulations, bylaws and credit policies of the club. 

DATE: ______________        SIGNATURE _______________________________________ 
PLEASE PRINT OR TYPE ALL INFORMATION BELOW: 

Applicant Name: ___________________________________________ 

Applicant Age: _________________               Date of Birth: ______/______/______ 

Spouse’s Name: ____________________________________________ 

Spouse’s Age __________________              Date of Birth ______/______/_______
 
Dependents – Names and Ages: _________________________________         ____________
                                                  _________________________________         ____________ 
  
 Home Address: _____________________________________________________________
                          _____________________________________________________________

Home Telephone: _(____)_______________  E-Mail ___________________________
Applicant Occupation: ____________________________________________________
Business Name & Address   ____________________________________________________
                                            ____________________________________________________
Business Telephone: _(____)_____________  E-Mail ________________________________

Spouse’s Occupation: _________________________________________________________
Spouse’s Business Name & Address   _____________________________________________
                                                           _____________________________________________

Spouse’s Business Telephone: _(____)____________     E-Mail _________________________

Billing Preference: Home or Business _____________________________________ 
Second/Seasonal Address: _____________________________________________________
                                           _____________________________________________________
______ CHECK ATTACHED 
______ CHARGE TO VISA/MASTER CARD ACCOUNT NUMBER 
__ __ __ __    __ __ __ __   __ __ __ __   __ __ __ __     Exp. Date  ____/____ 

If the CAPITAL ASSESSMENT is required (over 35 years old):
Check Payment method:_____ $250;  _____  Bill $20.84 monthly

Mail to: Reedsburg Country Club, PO Box 125, Reedsburg, WI 53959                     Clubhouse: (608) 524-3134