Type of Membership
Billing Address (if Different)
Education & Organization
Were you referred?
PHOTO RELEASE: From time to time, Willoughby Golf Club or the media will take photos of our members which include, but are not limited to: youth
activities, special events, sporting events, Club events and special shoots for publicity reasons. These photos may be used in our newsletters, brochures,
social media, online advertising, print ads and the Willoughby Golf Club website, to advertise, promote and recognize Club members. By signing the
application for membership you acknowledge that your photo(s) may be used for these purposes. If you are opposed to your photo being used you must state
so separately in writing to the Club that you do not give permission for you or your family’s photos to be used for these purposes.
CONFORMANCE TO RULES: If accepted for membership at Willoughby Golf Club, I will abide by the rules and regulations of the Club and any rules and regulations as may be passed from time to time by the Board of Directors.
AUTHORIZATION TO CONTACT REFERENCES: I authorize Willoughby Golf Club (inclusively Club Administrative staff, Membership Committee, Directors and Officers) to contact the references (inclusively any person or organization listed within this application and any other organization or persons contacted by the Club). I also authorize said references to disclose to Club representatives information the Club deems necessary or appropriate in connection with the review of my application. I understand and agree that Club representatives will disclose to one another such information that
is received as they may deem necessary or appropriate in connection with the review of my application. Without any liability on their part, and except as described herein, Club representatives agree that the information obtained will be maintained in confidence. I agree to hold the references, Club representatives and Willoughby Golf Club harmless and release them from any liability or damages I may incur from any cause whatsoever arising from disclosure or information and the investigations by Club representatives. I understand that the Membership Committee and the Board of Directors will make the ultimate determination to accept or reject my application for membership. I further agree to make no claim against the Club representatives, references or Willoughby Golf Club, Inc. relating to rejection of my membership application for any cause and whether arbitrary or otherwise.
REJECTION: I also understand that should the application for membership be rejected, no reason for rejection will be provided to me. The Club representatives will maintain documents relating to their review of a rejected application, including any reasons for which the application is rejected, in a sealed file.
PAYMENT: I understand that I will be responsible for payment in full of all fees pertaining to my Membership within 30 days of my approval of this application and that my current years’ dues will be pro-rated subject to procedures set for in the By-Laws of Willoughby Golf Club, Inc.