Pike County Country Club
Pike County Country Club
19538 Highway 54
Louisiana, MO 63353
ph: (573) 754-7944
golf
Prospective Members
PIKE COUNTY COUNTRY CLUB, INC.
MEMBERSHIP APPLICATION
If the applicant is accepted for membership into Pike County Country Club, by accepting such membership, the member ratifies all prior acts of the Officers and Governors and agrees to be bound by the terms of the Club's Articles of Agreement, the By-Laws, and all rules and regulations promulgated by the Board of Governors and teh various committees of the Club. (Please type or print all form entries)
TYPE OF MEMBERSHIP APPLYING FOR:
SOCIAL_________ GOLF__________
Please check which membership services below you are interested in applying for.
_____Cart _____Trail Fees _____Shed _____Handicap
PERSONAL INFORMATION
Full Name:___________________________________________Age:_____
Residence Address:_________________City:_______________________Zip_______
Home Phone:_________________________________
Occupation, Title or Profession:____________________________________________
Business Address:__________________City:______________________Zip:_______
Office Phone:________________________________________________________
Name of Spouse:______________________________________________________
Name and ages of dependent children:____________________________________________________________
Have you ever been a member before? _______when?_________
MEMBERSHIP REFERENCES-Please use current members of PCCC
1st Member Sponser
1. ________________________________________________________________
Name Address City State Phone
2._________________________________________________________________
Name Address City State Phone
3._________________________________________________________________
Name Address City State Phone
________________________________________ _____________
Signature of Aplicant Date
Date Application Received:__________________
Date Application Posted: __________________
New Member Specials
- 1st year- $700 membership dues + $100 initiation+$50 stock fee
- 2nd year- $950 membership dues
- 3rd year- $1155 membership dues
- Junior Memberships-$300
**cart sheds are availiable for a fee**
Pike County Country Club is a private golf course not open to the general public. For information on accompanying a member to this course or applying for membership, please contact Pike County Country Club directly for details.
Pike County Country Club
19538 Highway 54
Louisiana, MO 63353
ph: (573) 754-7944
golf
