Mid Carolina Club, Inc.
Application for Membership
Personal Information (please print)
Name:
Home Address:
City: State: Zip:
Home Phone: Email:
Cell/Other Phone: Date of Birth:
Previous Address (if less than 1 year):
City: State: Zip:
Marital Status: Married Single (please circle)
Employer: Type of Business:
Position: Business Phone:
Business Address:
City: State: Zip:
Spouse Information
Spouse’s Name: Date of Birth:
Email:
Employer: Type of Business:
Position: Business Phone:
Business Address:
City: State: Zip:
Dependant Information (under 21 or full-time student 25)
Name: Date of Birth: MaleFemale
Name: Date of Birth: MaleFemale
Name: Date of Birth: MaleFemale
Name: Date of Birth: MaleFemale
Name: Date of Birth: MaleFemale
Bank Reference & Location:
Credit Reference & Location:
HOW DID YOU HEAR ABOUT US? ______
Previous Club Affiliations
This application must be filled out in its entirety and applicant must be sponsored by two (2) existing Mid Carolina Club members in good standing prior to its acceptance for consideration.
Authorization: Upon signing this application, I hereby grant permission to Mid Carolina Club to verify credit history and affiliation record and authorize those persons or entities herein to furnish information to Mid Carolina Club
Club Policy and By-Laws: The undersigned agrees to conform to and be bound by the Policies and Rules of the Club as they may be amended from time to time.
Resignation: It is agreed that a member may resign from the club at any time by submitting written notification to the Club Business Office. All dues and charges for which the member is liable are due through the end of the month of the resignation.
Payment of Account: All club activities are due at the time of service. Mid Carolina Club does not offer member charge. Dues may be paid annually or monthly. The undersigned agrees to pay any and all dues, fees and other charges that may be assessed to members by Mid Carolina Club. Any Past due balance for member dues are subject to a late fee as set forth in Club Policy. The undersigned agrees to pay all reasonable attorney and/or court costs in the event that this account is turned over for collection.
Applicant’s Signature: Date:
Spouse’s Signature: Date:
Sponsorship (Current Members)
Member Signature: Date:
Member Signature: Date:
For Club Use Only
Accepted Date: Join Date:
Member Number: Membership Committee Chair:
Mid Carolina Club, Inc.
3593 Kiblers Bridge Road
Prosperity, SC29127
803-345-6039, 803-364-3193
email: