Dynamic Form - Field Club of Omaha

* I hereby apply for membership and the resultant rights and privileges therein. I understand my name(s) and phone number(s) will be listed in the Member Directory available to Members only and is not used for solicitation purposes.

I understand

-I would like to apply for membership in the following category:

* First and Last Name

* Date of Birth

* Address

* City, State

* Zip code

* Email:

* Phone

* Employer

* Occupation

Does your Spouse/Significant Other golf?

Spouse/Significant Other Name

Spouse/Significant Other Phone:

Spouse/Significant Other Email

Spouse/Significant Other Date of Birth

Spouse/Significant Other Employer:

Spouse/Significant Other Job Title:

Anniversary:

Child #1 Name & DOB:

Child #2 Name & DOB:

Child #3 Name & DOB:

Child #4 Name & DOB:

Child #5 Name & DOB:

Membership bylaws require the Member to pay dues and all other additional ancillary charges to your member account by auto billpay. First months dues and initiation are due upon acceptance of application per the outline of the membership type selected above. Select ACH type:

Checking

Savings

Account Holder Name:

*Account Number:

Routing Number:

I would like to add the following services to my account:

Club storage, (1) Men's Golf Association, (1) Handicap and Hole-in-One Fund participation are required with Golf Membership. Membership Resignation Policy: Membership is an annual commitment with the Membership Year running July 1-June 30. Resignations are accepted once a year with a 30 day written notice prior to the July 1st renewal date. You may enroll at anytime prior to July 1 with a minimum initial commitment of a 1 year term.

I understand

* Referred by/Member Sponsor

* The undersigned hereby applies for membership and the resultant rights and privileges therein. If accepted, I understand my name (s) and phone number(s) will be listed on the Member Roster as follows and is not used for solicitation purposes. I agree to comply with and be bound by the Club’s Rules and Regulations as they may be amended from time to time. I understand and agree that the Temporary Membership I have received is not a final acceptance of my application. If the Club does not accept this application, the Temporary Membership will be voided and all funds paid for the membership will be promptly refunded, and this application will be cancelled and will not be binding on either party. The Club reserves the right to decline this membership application at any time in its sole discretion. If my application is approved my permanent Membership will begin on the date a duly authorized representative of the Club executes the “Approved By” line. Approved by_________________________on this ____date of _______, 202_.

APPLICATION FOR PRIVATE CLUB MEMBERSHIP