Membership Application 2009


Last Name Family:_____________________________________________________________

First Name Wife:______________________________ 

Husband:_______________________________

Address:____________________________________________________________________

City:_____________________________________  Zip code:__________________________

Telephone (H):_____________________________ (W):______________________________

Email:____________________________________

Business:  Name:___________________________  Type: _____________________________


Children
Name
Birth Month/Year

1._________________________________________
/

2._________________________________________
/

3._________________________________________
/

4._________________________________________
/

5._________________________________________
/
 
Please list two (2) current club members who will be willing to sponsor your application

1.___________________________________________________________________

2.___________________________________________________________________



I/we agree to abide by the Rules and By-Laws of the Paugusset Club, Inc. and to act in anappropriate manner while on the premises and to supervise any children or guests so that they act in aproper manner that does not annoy other members and guests. Failure to follow the rules or actappropriately or supervise your guests and children can and likely will result in disciplinary actionssuch as fines, suspension of club privileges and/or expulsion. We/I also agree to fulfill all financialobligations my family incurs as a member of the Paugusset Club. In addition, we/I agree to pay all collection costs should we/I fail to pay all amounts due or owing, including all Attorney's fees.

Signature:___________________________________________ Date:___________________

___________________________________________
 


Both parents must sign this application if a family membership is being requested before your application can be considered.
 
Last Updated:Sunday, June 7, 2009 0:31 AM