PENDLETON COUNTRY CLUB, INC.
317 COUNTRY CLUB DRIVE
BUTLER, KY. 41006
Phone: 859-472-2150
2012 APPLICATION FOR
MEMBERSHIP
I hereby apply for a CORPORATE ( ), FAMILY( )
CO-ED( ) ---$1730.00 SENIOR FAMILY( )
---$1415.00
SUPER SENIOR FAMILY (
)---$1152.00 JUNIOR FAMILY(
)---$1100.00 SINGLE ( )---$1310.00
SENIOR SINGLE ( )---$1152.00 SUPER SENIOR SINGLE
( )---$995.00 JUNIOR SINGLE (
)---$845.00 membership in the Pendleton Country
Club. (Please check the appropriate
membership.)
Junior
(ages up to 31) Senior (ages 65 to 74) Super Senior
(ages 75 and above )
Initiation
Fee $1000.00 (waived for limited time)
Yearly
Dues $_______________
Name of Applicant
___________________________________________
Spouse ___________________________________________
Address ___________________________________________
___________________________________________
Home
Phone _________________________ Cell Phone
_______________________
Email ____________________________________________
Names of unmarried children living at home:
1)_______________AGE______
4)_______________AGE______
2)_______________AGE______
5)_______________AGE______
3)_______________AGE______
6)_______________AGE______
Place of Employment_______________________________________________
Address of
Business_______________________________________________
Business
Phone______________________
Member Sponsored by____________________________________
I hereby agree to abide by the by-laws and the Rules
and Regulations of Pendleton Country Club.
Enclosed is my check for $___________________
Signed
___________________________________
Application Approved _______________ Date__________________