Membership Information Survey Form 2019 PLEASE FILL OUT THE INFORMATION BELOW:Member Number*Name* First Last Spouse Name First Last Email* Spouse Email Birthday* Date Format: MM slash DD slash YYYY Spouse Birthday Date Format: MM slash DD slash YYYY Phone No. (Cell)*Spouse Phone No. (Cell)Billing Email Children’s NameAge 21 and underNameBirthday Grandchildren’s NameAge 21 and under* Primary Mailing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone No. (H)*Newsletter Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Professional Occupation/Company NameSpouse – Professional Occupation/Company NameCollege Attended*Spouse - College AttendedAreas of Club Activity and Interest* Golf Golf/Spouse Tennis Tennis/Spouse Spa Marina Fitness Pool Events HandicapHandicap/SpousePersonal CartYesNoMarina Slip #Men’s Locker #Women’s Locker #Family Social ActivitiesYesNoGeneral Social ActivitiesYesNoWine ActivitiesYesNoFamily Dining EventsYesNoTripsYesNoLecturesYesNoParticipation ClassesYesNoGolf LessonsYesNoTennis LessonsYesNoKids’ Programs & EventsYesNo
