APPLICATON

                           2012 APPLICATION FOR ANNUAL PASS TO : GRAND OAK GOLF CLUB

I HEREBY APPLY FOR THE FOLLOWING TYPE OF ANNUAL PASS TO GRAND OAK GOLF CLUB:

                                   [    ]  INDIVIDUAL  PASS          $1000 ANNUAL FEE

                                   [    ] FAMILY  PASS                  $1700 ANNUAL FEE

                                   [    ] WEEKDAY PASS               $650 ANNUAL FEE

                                   [    ] JUNIOR PASS                    $250 ANNUAL FEE

NAME__________________________________ HOME____________________________________

DOB_________________________________________________

PHONE(___)______-_________

BUSINESS NAME AND ADDRESS_________________________________________

_____________________________________________

BUSINESS PHONE(___)____-_______

EMAIL:______________________________________

IF APPLYING FOR A FAMILY ANNUAL PASS, PLEASE COMPLETE THE FOLLOWING INFORMATIION REGARDING FAMILY MEMBERS. PLEASE NOTE THE FAMILY MEMBERSHIP INCLUDES CHILDRED UP TO THE AGE OF 21. 

SPOUSE’S NAME________________  DOB_______________________

CHILDREN_____________________   DOB_____________________

                 I AGREE TO BE BOUND BY THE RULES AND REGULATIONS OF THE GRAND OAK GOLF CLUB NOW IN EFFECT AND THOSE WHICH MAY BE ADOPTED HEREAFTER. I UNDERSTAND THAT THE GRAND OAK ANNUAL PASS IN NON-TRANSFERABEL AND NON-REFUNDABLE.

SIGNATURE__________________________________________   DATE________________________________

MAKE CHECK IN THE AMOUNT INDICATED PAYABLE TO : GRAND OAK GOLF CLUB.  370 GRAND OAK DRIVE, WEST HARRISON , INDIANA  47060   PH(812)637-3943   FAX (812)637-3913   WWW.GRANDOAKGOLFCLUB.NET