Special Membership Application

Step 1: Nominee to complete form by responding to all questions. Step 2: Once form has been completed please select "Submit" at the bottom of the page.

"*" indicates required fields

Name*

First Last

Home Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone No.

Mobile Phone No.

Business Phone No.

Email Address*

Name of Spouse/Partner

First Last

Spouse/Partner Contact No.

Date of Birth

Profession/Occupation

Name of Business/Employer

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Education

Relocated From

Relocation Dates

Circumstances of Relocation

Provide background on family relocating including children, schooling etc

Names of Clubs which Applicant is a Member

Name of Clubs from which Applicant has resigned

Please provide two (2) written Club references

Reference 1

Reference 2

Names of any Elanora Members you may know and / or have played golf with recently

Date*

Applicant Signature*

(Electronic signature not required, please type name as confirmation of declaration)