Kwinana Golf Club

Please complete the following
Surname		Given Name(s)
Title		Date Of Birth
Membership Type	valid from 22/12/08 - 31/03/10
Address
Postcode
Phone (Hm)		Phone (Wk)
Phone (Mb)		Fax
		Email
Occupation		Employer
Marital Status		Next of Kin

Previous Golf Club Membership held at
Handicap
If applicable - Members of Kwinana Golf Club that will support my nomination
Proposer		Seconder
Period known

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Acceptance of the application is conditional upon being accepted by the management committee

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