Membership Application

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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.


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.)

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


Applicant Employment
Spouse Employment

Personal Data

Applicant Personal

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

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
Misc and Finalize

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. 

Lafayette Country Club
1500 South Ninth Street
Lafayette Indiana
(765) 474-3461


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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