Applicants Full Name _______________________________

Date __________

Address

________________________________________________________

________________________________________________________

________________________________________________________

Post Code _______________

Tel. No _______________

School ______________

Date of Birth _______________

How long have you lived at the above address ________Years

Previous Club (If any) ________________________________

Present Club (If any) ________________________________

Are you a Golfing Beginner YES / NO

Handicap (if any) __________________

Signature ________________________________

Club Referee 1 __________________________
(Please Print Name in Capitals)

Club Referee 2 __________________________
(Please Print Name in Capitals)

The Club prefers referees to be voting members of Pontypool Golf Club, to both of whom you must be personally known.
If members of the Club are not known to the candidate for any reason then Two School referees may be used.

Other Referee 1

Name

___________________________________

Address

________________________________________________________

________________________________________________________

________________________________________________________

Post Code _______________

Tel. No. _________________

Other Referee 2

Name

___________________________________

Address

________________________________________________________

________________________________________________________

________________________________________________________

Post Code _______________

Tel. No. _________________

I desire to become a Playing Junior Member of the Pontypool Golf Club and agree at all times to be bound by it's Rules and Regulations