Online membership form - Queenstown Golf Club

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Online Membership Form

Membership Form

First Name*

Last Name*

Gender*

Male Female

Home Phone Number*

Work Phone Number

Fax Number

Mobile Phone Number

Address Line 1*

Address Line 2*

City*

Post Code*

Email Address*

Date of Birth

Are you currently a member or have you ever been a member of a NZ Golf affiliated golf club? Yes

Membership Number

Occupation*

Introduced By (Member):

Are you a New Zealand Citizen?*

Yes No

Membership Type Requested*

Emergency Contact Name

Emergency Contact Number

Privacy Statement: The information collected in this form will be used in accordance with the principles of the Privacy Act of 1993. The information will not be used for any other purpose than for a lawful purpose connected to the Club. By submitting this form, you acknowledge your rights to view and amend the information.

Please tick:

*NZ Country – Must be a member of another NZ club over 30kms away from Queenstown Golf Club

**Limited Membership category is a Membership Category for spouse or partners of Full Members. Only entitled to play with spouse or partner, is not entitled for a handicap and does not have voting rights.

	Address: 759 Peninsula Road Kelvin Heights Queenstown New Zealand
	Phone: (03) 442 9169 ex 2
	Email: proshop@queenstowngolf.co.nz