JUNIOR MEMBERSHIP APPLICATION FORM JUNIOR MEMBERSHIP NOMINATION FORM NAME Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Membership Category*Junior 13-17yrsJunior Under 13 yrsJunior Introductory- SWGS JUNIOR PROGRAM PARTICIPANTMembership fees are charged pro rata to September 30. Payment method*Pay in FullPlease contact me to discuss other optionsMonthly or quarterly payment plans attract a $60p.a. admin fee split across the payment schedule. Note: Any levies will be billed with the 1st payment installment. Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Age*Date of Birth* Mobile*Phone (Home)EMAIL* Emergency Contact Details* Name Relationship Mobile Are you currently participating in a Shani Waugh Golf School Program?* Yes No Do you have any allergies which may effect medical treatment?e.g Allergic reaction to bee stings, food allergies or other allergiesPrevious Golf Membership InformationHave you ever been or are you a current junior member of another club?*YesNoIf yes, please enter details below [Club Name, Current or Past Member]Please enter Golflink NumberIf you are a current member at another club, do you wish to nominate Bunbury as your "Home Club"?*YesNoI am not a current member of another clubMembership DeclarationName a person who introduced you to the club? (Leave blank if not applicable)Please list member names below for whom has agreed to Propose & Second your nomination.ProposerSeconder Members listed will be contacted by administration to confirm. Note: If you do not have a proposer or seconder, we will contact you for additional information on receipt of application.Parental / Guardian Consent* Select All I consent for the Junior nominated above to become a Member of Bunbury Golf Club Collecting my children's personal images by photo, film or other electronic devices Using my children's personal images in any internal or publicly available form Administer or obtain any emergency treatment deemed necesary for my child due to accident or illness sustained whilst within the Club precincts Parent/Guardian consent details* First Last Mobile How did you hear about joining Bunbury Golf Club Select All Social Media TV commercial Website Google Member referral Word of mouth Other CAPTCHA
