PO Box 39, Umkomaas, 4170

 

E-Mail: info@umkomaasgolf.co.za

 

Website: www.umkomaasgolf.co.za

 

 

 

Telephone Office: (039) 973 1042

 

Telephone Golf Shop: (039) 973 1330

Please print and complete the form then mail

 Fax  (039) 973 1059

it to the address alongside!

 

Date of Application;

D

D

M

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Y

Y

Y

 

Title/Fore Names/Surname

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Physical address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Code

 

 

 

 

Postal address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Code

 

 

 

 

 

ID/Passport No.

 

 

 

 

 

 

 

 

 

 

 

 

 

Birth Date

D

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M

Y

Y

Y

Y

Occupation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employer

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Tel. Home

 

 

 

 

 

 

 

 

 

 

Tel. Business

 

 

 

 

 

 

 

 

 

 

 

Mobile #

 

 

 

 

 

 

 

 

 

 

Fax Number

 

 

 

 

 

 

 

 

 

 

 

E-Mail Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Tick Type of membership required

Full

Family

Student

Scholar

Social

Country

Other

Note: Proof will be required if applying for Student/Scholar/Senior Membership and in the case of Country Membership the name of your Home Club to be inserted on the line below:-
                                                 

 

For Family membership please supply:-

First Name

Birth Date

Spouse

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D

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M

Y

Y

Y

Y

Child 1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D

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M

Y

Y

Y

Y

Child 2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D

D

M

M

Y

Y

Y

Y

Child 3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D

D

M

M

Y

Y

Y

Y

 

Emergency Contact Name:                                                              Relationship:

Contact Number:

2nd Contact Number:

 

Present/Previous membership at other Golf Clubs:-

Name of Club

 

 

 

 

 

 

 

 

 

 

 

 

 

 

How many Years?

 

 

Province/Country

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reason for leaving

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Present/Previous membership at other Golf Clubs:-

Name of Club

 

 

 

 

 

 

 

 

 

 

 

 

 

 

How many Years?

 

 

Province/Country

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reason for leaving

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Last/Current Handicap

 

 

As At?

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Y

Y

Y

Y

 

I the undersigned hereby apply for Membership of the Umkomaas Golf Club. I further undertake that I have not been requested to resign from, nor refused membership, of any other Club due to misconduct on my part and confirm the accuracy of information submitted per this application.

 

Signature

 

 

 

 

 

 

 

 

 

 

 

 

Date

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Y

 

 

 

 

 

 

 

 

 

 

 

                                                                                                                Page 2

                                                        

We the undersigned recommend the above named applicant as a suitable member for Umkomaas Golf Club and understand that from the date of election we will be held responsible for his/her conduct as a member of the Club.

 

Proposer Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature

 

 

 

 

 

 

 

 

 

 

 

Date

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Y

Y

Y

Y

 

Seconder Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature

 

 

 

 

 

 

 

 

 

 

 

Date

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Y

 

                                                                        _____oOo_____

 

THIS SECTION FOR OFFICE USE ONLY:

 

Membership Fee

 

 

 

 

Fee’s Can be deposited to:-      Umkomaas Golf Club

                                                Standard Bank Scottburgh

                                                Branch Number: 057627

                                                Account Number: 052874346

(Proof of deposit will be required)

NGU/NLGU

 

 

 

 

Southern Districts

 

 

 

 

Swipe Cards

 

 

 

 

Other

 

 

 

 

Total

 

 

 

 

 

 

Receipt Number

 

 

 

 

 

Date

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Y