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Radley Run Country Club Confidential Personal Information Form

Name

Phone

Address

Email

Spouse E-Mail

Membership Category (please check one)

Golf Equity Deferred Golf Young Professional Golf* Intermediate Golf*

Sports

Social

Young Professional Sports*

Golf Warrant

Intermediate Sports*

Social/Pool

Legacy

Trial Social

*Proof of age required.

Members of family, including candidate, who will qualify for privileges under the provision of the membership classification requested:

Name

Relationship

Date of Birth

1.

Candidate

2.

3.

4.

5.

6.

Employment, Candidate

Company Name Address

Job Title Phone Fax

Employment, Spouse Company Name

Address

Job Title Phone Fax

Colleges or Universities Attended:

Candiate Spouse

Hobbies and/or Interests:

Candidate Spouse

Past or Present Membership in Other Clubs: Name & Address of Club(s)

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