JUNIOR MEMBERSHIP APPLICATION FORM JUNIOR MEMBERSHIP NOMINATION FORM NAME Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Membership Category* Junior 13-17yrs Junior Under 13 yrs Junior Golf Academy Introductory Member Membership fees are charged pro rata to September 30. Payment method* Pay in Full Please contact me to discuss other options Monthly or quarterly payment plans attract a $60p.a. admin fee split across the payment schedule. Note: Any levies will be billed with the 1st payment installment. Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Age*Date of Birth* MM slash DD slash YYYY Mobile*Phone (Home)EMAIL* Emergency Contact Details* Name Relationship Mobile Are you currently participating in a BGC Junior Academy Program?* Yes No Do you have any allergies which may effect medical treatment?e.g Allergic reaction to bee stings, food allergies or other allergiesPrevious Golf Membership InformationHave you ever been or are you a current junior member of another club?* Yes No If yes, please enter details below [Club Name, Current or Past Member]Please enter Golflink NumberIf you are a current member at another club, do you wish to nominate Bunbury as your "Home Club"?* Yes No I am not a current member of another club Membership DeclarationName a person who introduced you to the club? (Leave blank if not applicable)Please list member names below for whom has agreed to Propose & Second your nomination.ProposerSeconder Members listed will be contacted by administration to confirm. Note: If you do not have a proposer or seconder, we will contact you for additional information on receipt of application.Parental / Guardian Consent* Select All I consent for the Junior nominated above to become a Member of Bunbury Golf Club Collecting my children's personal images by photo, film or other electronic devices Using my children's personal images in any internal or publicly available form Administer or obtain any emergency treatment deemed necesary for my child due to accident or illness sustained whilst within the Club precincts Parent/Guardian consent details* First Last Mobile How did you hear about joining Bunbury Golf Club Select All Social Media TV commercial Website Google Member referral Word of mouth Other CAPTCHA
