INDIAN LAKE COUNTRY CLUB

MEMBERSHIP APPLICATION FORM

INDIANAPOLIS

Please complete this form with all applicable information, then print, sign, date and submit to office.  Upon review the Membership Committee will contact you regarding status.
Primary Member:
First Name
Middle Initial
Last Name
Date of Birth
Sex
Street Address
Address (cont.)
City
State
Zip/Postal Code
Home Phone
Cell Phone
E-mail
Marital Status
Member Type Requested:

Family Golf (Married, 2 golfers)
Golf/Social (Married, 1 golfer)
Family Social (Married)
Single Golf
Single Social

Spouse:
First Name
Middle Initial
Last Name
Date of Birth
Sex
Cell Phone
E-mail

 
Employment:
Employer
Street Address
Address (cont.)
City
State
Zip/Postal Code
Occupation
Work Phone

E-mail
Spouse Employment:
Employer
Street Address
Address (cont.)
City
State
Zip/Postal Code
Occupation
Work Phone
E-mail

Children (Under Age 23):

First Name M. Last Name Sex Date of Birth
Interests:
 Ladies' Golf League
Euchre Club
Bowling League

Referred By (Member Name):   

By signing I acknowledge that I have read and agree
to the published club policies and the financial commitments thereof.

Signature/Date

                                                             
Copyright © 2007 Indian Lake Country Club. All rights reserved.                                                                                                        Revised: 12/23/07