Applicant Signature & Billing Preferences Information: Mailing Preference Home or Business:______________________________________
Dues Billing Frequency; Monthly, Quarterly, Semi-Annual, Annual: _______________________________________________________________________________
Statement Preference; Mail, Email or Both: ________________________________________________________________________________
Applicant Signature:__________________________________________________________ (I herby make application for membership at Chartiers Country Club. If electe I agree to be governed by the By-Laws & all rules & regulations, as well as special decisions by the Board of Directors.) Interview Information: Interview Completion Date: __________________________________________________
Interviewer Name: ____________________________________________________________
Interviewer Signature: ________________________________________________________
Membership Director Signature: _____________________________________________
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