ENQUIRIES Membership Enquiry Your Details: Title Mr Mrs Miss Ms Master Dr Sir Lady Rev Surname * Initials Given Name(s) * Preferred Name: Date of Birth: * Address: * * City * Zip/Postal Code Primary Phone number: * Other Phone: Fax: Email * Occupation: Employer: Work Address: Street Address City ZIP / Postal Code Permanent Resident of the Gold Coast: Yes No Number of Years: Visa: Visa Status: Permanent Pensioner Next of Kin: Relationship: Next of Kin Phone: Membership Type: * Please select Ordinary Women Limited Playing Junior 21 to under 25 Junior under 21 If the nominated category is closed, do you wish to enter a lesser category until vacancies become available?: No Yes Details of other sporting and social club membership past and present: Golf Experience: Handicap: GolfLink No: Home Club: Have you ever been refused membership at any other club? * Yes No If applicable - Members of Southport Golf Club that will support my nomination: Proposer: Seconder: Period known: Period known: Do not know a member? Please tick Name and Contacts of 3 Referees: 1. Name: Phone: 2. Name: Phone: 3. Name: Phone: How did you find out About Southport?: Please Select: * Select Member Newspaper Radio Internet Location Other I hereby agree that, * if elected, to abided by the Rules and By-Laws as laid down in the Memorandum and Articles of Association in force at present, or may be decreed in future by the Committee of Management Submit If you are human, leave this field blank.