Junior Membership Application

Name*

First Last

Preferred Name

Title

Mr
Mrs
Ms
Miss

Date of Birth*

Parent or Gaurdian Name*

First Last

Phone*

Parent or Gaurdian Name

First Last

Phone

Email*

Address*

Town/Suburb*

State*

Postcode*

School

Membership Details

Golf Details

Have you ever been a member of Virginia Golf Club previously*

Yes
No

If you have previously been a member of a Golf Club, please advise the following details*

Yes
No

Club Name

Membership Status

Current
Resigned

Last Handicap

Golf Handicap (Current AGU/LGU)

Existing Golf Link Number

Make Virginia Golf Club my home club*

Yes
No

The Australian Golf Union (AGU) requires the information requested above for the purposes of GOLF Link. Your personal information will only be used in accordance with the GOLF Link “Activity” and to provide you with GOLF Link services. If the requested information is not provided to the AGU you may not be able to obtain GOLF Link Services including an official Australian handicap. Should you wish, you will be able to access your personal information through the AGU upon reasonable notice.

Member Declaration

Declaration*

I certify that the above information is true and correct in every particular and I acknowledge that the Committee and/or Club may at their sole and absolute discretion refrain from or refuse to elect me to Membership without assigning any reason therefore. If elected, I undertake to abide by the Rules and By- Laws of the Club.

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OFFICE USE ONLY

Member Number __________________________________
Infotel
Card/ Members Pack
Invoice/ welcome email
Miclub/ GL
Payment
Points

Junior Membership Application