New Member Application

DATE :
Full Name : *
Address : *
City/State/Zip : *
DOB : *
Age *
E-Mail Address : *
Home Phone :
Cell Phone
Office Phone :
MEMBERSHIP CATEGORIES:
If Rejoin, Initiation or Certificate $ :
Name
DOB :
E-Mail Address :
Cell Phone
Office Phone :
Name
Name
Name
Gender :
Gender :
Gender :
DOB :
DOB :
DOB :
Current Employer : *
Address : *
City, State, Zip :
Dates Employed :
Position : *
Previous Employer:
Dates Employed :
Position :
State
  • --Select--
  • AK
  • AL
  • AR
  • AZ
  • CA
  • CO
  • CT
  • DC
  • DE
  • FL
  • GA
  • HI
  • IA
  • ID
  • IL
  • IN
  • KS
  • KY
  • LA
  • MA
  • MD
  • ME
  • MI
  • MN
  • MO
  • MS
  • MT
  • NC
  • ND
  • NE
  • NH
  • NJ
  • NM
  • NV
  • NY
  • OH
  • OK
  • OR
  • PA
  • RI
  • SC
  • SD
  • TN
  • TX
  • UT
  • VA
  • VT
  • WA
  • WI
  • WV
  • WY
Name *
Type of Relation to Applicant :
College/University :
Degree :
Years Attended :
College/University :
Degree :
Years Attended :
Current Employer :
Address :
City/State/Zip :
Dates Employed :
Position :
High School :
City/State :
College/University :
Degree :
Years Attended :
College/University :
Degree :
Years Attended :
Please tell us why you have chosen to apply for membership to The Standard Club. *
Please indicate the contact information you would like to share with fellow members on the private member section of www.standardclub.org:
Statement to be e-mailed to this address :
E-mail Blasts (Weekly) :
You may want to include where you and your spouse (if applicable) work/title, colleges attended, hobbies/interests, etc. Please write 3-4 sentences introducing yourself and or your family to the club. This will be shown under your photo on the new member board. *
Please list any clubs, organizations or associations in which you may be affiliated : *
I
Please Initial : *
Applicant Signature : *
DATE :
I
Please choose a date below
Billing Address :
Phone# :
City, State, Zip :
E-mail :
Account-Type:
Name on Acct :
Account Number :
Expiration Date :
SIGNATURE :
DATE :
I
Please choose a date below
Billing Address :
Phone# :
City, State, Zip :
Email :
Account Type :
Name on Acct :
Bank Name :
Account Number :
Bank Routing # :
Bank City/State :
SIGNATURE :
DATE :
The cost for registering for this special club is $0. How does this work you ask? When a Member of the HIOC hits a hole-in-one, the other Members of the HIOC will have $5 billed to their account. The lucky person that hits the hole-in-one,lets just say it is YOU, walks away with an average of $890 to $1050 in Golf Shop credit and a big smile on your face. (Each hole-in-one must be verified by a witness and reported to the Golf Shop immediately after your round of golf has been completed.)
Member Name (Printed) :
Standard Club Representative Printed Name :
Member Signature :
Standard Club Representative Signature :