Fairbury Country Club Membership Application

Date:	Referred By:
Name:	Email:
Address:	City:	State:	Zip:
Home Phone:	Work Phone:	Cell Phone:
Occupation:
Marital Status:	Single	Married
Spouse's Name:	Email:
Home Phone:	Work Phone:	Cell Phone:
Occupation:
Children Living At Home:	Name:	Age:
	Name:	Age:
	Name:	Age:
Have You Ever Been A Member?	Yes, when?	No (first time member)
Please Send Me Club News & Updates By		Email	Regular Mail
Questions Or Comments?
I hearby apply for Fairbury Country Club Membership and agree to abide by the rules and by-laws of the Fairbury Country Club.
By Submitting This Form I hearby apply for Fairbury Country Club Membership and Agree to Abide by the rules and by-laws of the Fairbury Country Club
You will be contacted upon approval of your application.