Applicant		Co-Applicant
Name:		Name:
Home Address:	Street No. & Name Suite No. City State Zip Code Country	Address (if different):	Street No. & Name Suite No. City State Zip Code Country
Email:		Email:
Day Phone (area code first):		Day Phone (area code first):
Evening Phone (area code first):		Evening Phone (area code first):
Number of Children: please select 0 1 2 3 4 5 6 7 8 9 10 more than 10
Ages of Children (separate with commas):
Applicant:		Co-Applicant:
Occupation:		Occupation:
Business Location:		Business Location:
Your position in Firm:		Your position in Firm:
For how long:		For how long:
Have you ever been a member of a private club? yes no
If yes: Name of Club		Length of time:
Location of Club
Previous Club: Name of Club		Length of time:
Location of Club
If you have resigned from any of these organizations, state name and reason:
Have you or your co-applicant ever been denied membership in any club or social organization, or has the application for membership in any club or social organization been withdrawn? yes no
Please provide a brief general description of the attributes you are seeking in a private club (a more detailed profile will be developed later):
Applicant:		Co-Applicant:
Do you play golf?	yes no	Do you play golf?	yes no
How long have you played?		How long have you played?
Approximate average score		Approximate average score
Handicap, if any		Handicap, if any
Do you actively play tennis? yes no		Do you actively play tennis? yes no
Do you own your own home? yes no
Have either of you ever been convicted of a felony? yes no
Upon submission of this information, our representative will personally contact you in order to develop your detailed membership profile. This information will be used to contact private clubs on your behalf without divulging your personal information. The applicants will be required to submit a signed declaration permitting Country Club Advisor to conduct an Investigative Consumer Credit in accordance with New York Fair Credit Reporting Act prior to being advised of the clubs expressing an interest in meeting with them.   Country Club Advisor will assist in providing both you and the potential club with the basic information needed in order to determine the applicability of pursuing possible membership options, however, Country Club Advisor makes no guarantee to any of the parties that a membership will ultimately be offered or accepted, or that the terms, conditions, or other attributes of any membership agreement are accurate or appropriate to suit any particular purpose. Country Club Advisor makes no guaranty or warranty, representation, or any other promise in regard to potential membership and acts solely as agent in placing the parties in contact with each other, without regard to membership rates, privileges, procedures, or suitability and all parties agree that the consummation of a membership is completely outside the authority or control of Country Club Advisor.