Membership Application

Please print this form and bring it with you to Otsego Club. Credit card information and signature must be given in person.

Click here for downloadable Membership Form that can be filled in offline.

Today's Date
Applicant's Name
Membership Type Applying for
Type
Category
Payment Option
Sponsoring Family Information
Name
Relationship
Account #

PERSONAL
Name (Last, First, Middle)		DOB
Spouse (Last, First, Middle)		DOB
Email Address
Alt. Email Address
Permanent Residence (all communications from the Club will be directed to this address and phone number)
Number, Street
City, State, Zip
Telephone
Alt. Phone
Fax
Secondary Residence
Number, Street
City, State, Zip
Telephone
Alt. Telephone
Fax

Club Membership provides privileges for your unmarried children, up to four, under the age of 24 years and living at home or in school. Additional children will be charged. (See rate schedule)
	Name	Date of Birth
1.
2.
3.
4.

BUSINESS
Applicant's Occupation/Title
Company Name
Mailing Address
City
State
Zip
Telephone
Years in Present Employment
Spouse's Occupation/Title
Company Name
Mailing Address
City
State
Zip
Telephone
Years in Present Employment

SOCIAL
Additional Club Memberships
1.
	Current Member			Former Member		# of Years
2.
	Current Member			Former Member		# of Years
3.
	Current Member			Former Member		# of Years

PERSONAL REFERENCES (3) (Preferably Otsego Club Members, if available)
Name
Relationship		Years Known
Name
Relationship		Years Known
Name
Relationship		Years Known

CONFIRMATION OF ACCEPTANCE & ACKNOWLEDGMENT
If accepted as a Member, I, individually and on behalf of my family, hereby agree to conform to and be bound by the Conditions, Rules and By-Laws of the Club, as they may be amended from time to time. Further, my signature below confirms my understanding of the Conditions, Rules and Bylaws and the items noted in the application and assures the accuracy of completed information. Conditions and By-Laws may change without prior notice and will be in full force and effect equally to all Members as of date enacted.