Membership Application | Lafayette Country Club

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I (We) accede to the proposal of my (our) name(s) for membership in the Lafayette Country Club, Inc.; and make the following statements in connection therewith.

Note outlining the difference between membership classes goes here.

Class of Membership *

General Info

Full name of applicant(s) (If married, please list complete information for both husband and wife; if unmarried, please fill in applicable sections.)

Full Name *

Spouse Full Name

If the above is a married name, please enter Maiden Name

Residence (Number and Street Address)* *

City, State, Zip *

Home Phone *

Home FAX Number

Cell Phone Number

Email Address *

Number of years as a resident of Lafayette? *

year(s)

If applicant has resided in Lafayette less than five (5) years, please enter the following

Former residence (City/State)

From Date

Month

Day

Year

End Date

Month

Day

Year

Former Business Connection

Employment

Applicant Employment

Applicant Position *

Name of Firm *

Business Address (Number & Street/PO Box) *

City and State *

Business Phone *

Business Fax

Office Email *

Spouse Employment

Spouse Position *

Name of Firm *

Business Address (Number & Street/PO Box) *

City and State *

Business Phone *

Business Fax

Office Email *

Personal Data

Applicant Personal

Place of birth *

Date of Birth *

Month

Day

Year

University

Degree and year

Spouse Personal

Place of birth *

Date of Birth *

Month

Day

Year

University

Degree and year

Wedding Anniversary Date *

Month

Day

Year

If Applicants' parents are current members of the Lafayette Country Club, please list their names.

Applicant's Parents Names

Spouse's Parents Names

Children

Children under 18 (If you have more than 4 children, add the additional children's info in the comments) New fields will open as children's names are entered.

Children under 18

Child

Child 1 Full Name

Child 1 Date of Birth

Month

Day

Year

Child 1 Gender

Female

Male

Children over 18 (List only those who are unmarried, living at home, and attending college fulltime.) If you have more than the form allows for, add their info in comments.

Children over 18

Young Adult

18+ Child Full Name

18+ Child Date of Birth

Month

Day

Year

18+ Child Gender

Female

Male

Misc and Finalize

List other country club affiliations (if any), church memberships, affiliations of memberships in other clubs, societies, organizations, or associations.

Comments (and/or other children) or any other information you wish to divulge.

If accepted into membership, I (we) agree
to be governed by the Articles of Incorporation,
By-laws, and Rules of the Lafayette Country Club, Inc.
as they are now or as hereafter amended.

By entering my/our name(s) below, we agree to the following:

All statements above are correct and true to the best of my/our knowledge.
My/Our names, below, may be accepted as if we manually signed this document.
I/We agree to make the payment of the applicable initiation fee, if any, in a timely manner (which will be refunded in the event that the application is not approved). NOTE: Check or Credit Card is accepted.

Applicant Signature *

Spouse Signature

MEMBERSHIP BENEFITS...

The Lafayette Country Club is an oasis nestled in a wooded area in the center of town. It offers its members and guests a nearby vacation spot, a haven from the demands of everyday life. From its inception.

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