First Name* Last Name* Initial Date of Birth Phone Number Full Address Address Line 1* Address Line 2 City*State or Region*Canada Country Zip* Emergency Contact Name Emergency Contact Phone Email* Membership Type - Choose your membership for 2025 seasonSaturdays (The membership fee for 2025 is $165.00)Tuesdays (The membership fee for 2025 is $175.00 - Seniors 55 and older)Both days (The membership fee for 2025 is $245.00)Commitment and SignatureIf accepted as a member of the Nico Wynd Men’s Golf Club, I will conform to all Club rules and regulations and abide by the established Rules of Golf. Full name as Signature Date
