Membership Signup

Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Email

Phone

Birthdate

Employer/Occupation

Family/Significant Other:

Additional membership information for family/significant other living at above address who will be active members, or employee under the business classification. DOB necessary to determine classification level.

Name

First

Last

Relationship

Birthdate

Phone

Email

Membership Classification

Check box below for Membership Classification you are applying for.

If you were referred by a current member please list them here

Signature

Clear Signature

Application Date

Membership please Other:

Are you applying with a special?

FALL
BOBO
Not applying with special

Please select one

Family/Significant Other:

Membership Classification

Cortland's Premier
Golf & Private Club

Location

Phone

Email