Form Designer

Widows' and Widowers' Privileges

Your Information

I wish to apply for signing privileges as a widow of a member. I authorize you to charge annual dues and all usage fees for these privileges to my Club account. I assume full responsibility for the payment of these charges. The annual fee for this privilege is 50% of the annual dues for the regular membership category.

Your First Name *

Your Last Name *

Your Email *

Date of Birth *

Cell Phone *

Home Phone

By providing your phone number, you consent to receive text messages regarding club updates, events, and member notifications. Message and data rates may apply. You may opt out at any time.

Gender

Male

Female

Other

Other Amount

Your address if different from Member resident address

Address Line 2

City

State (abbreviated) / Province / Region

ZIP / Postal Code

Country

Deceased Member's Information

Deceased Member's Audit Number *

Deceased Member's Name *

Date of Death *

By checking this box, I hereby sign and authorize the Welcoming Committee to make any necessary actions and inquiries to process this application. I also agree to abide by the Club's By-Laws and House Rules if I become a member and to pay when due all Club charges when invoiced to me. *

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Form Designer

Widows' and Widowers' Privileges