Northern Dunes Golf Club
2026 Membership Application & Renewal Form
Member Information
Full Name: ___________________________
Date of Birth: ___ / ___ / ______
Mailing Address: ___________________________
___________________________
Phone Number: ___________________________
Email Address: ___________________________
Returning Member? ☐ Yes ☐ No
Membership Type (select one)
☐ Adult (46+) – $1,372
☐ Intermediate (18–45) – $1,062
☐ Couples (per person) – $1,165
☐ Couples Twilight (per person) – $721
☐ Twilight (after 2 pm) – $825
☐ Junior (17 & under) – $288
Discounts
☐ Apply Early Bird Discount (available until Nov 14, 2025)
☐ Discount for rounds played in 2025 (please specify amount): $ ____________
Optional Add-Ons (check all that apply)
☐ Power Cart (Single) – $598
☐ Twilight Cart – $391
☐ Couples Cart (per person) – $412
☐ Couples Twilight Cart (per person) – $309
☐ Simulator Access (with dues paid) – $618
☐ Simulator Access (no dues paid) – $825
Payment Information
Payment Method (check one):
☐ Credit Card ☐ Debit ☐ Cheque ☐ Cash
☐ Full Payment Enclosed
Credit Card Information (Complete only if paying by Credit Card)
- Cardholder Name: ___________________________
- Card Number: ___________________________
- Expiry Date (MM/YY): ____________
- CVV: ____________
- Billing Address (if different from above): ___________________________
___________________________
Member Agreement
By signing below, I agree to abide by all club rules, policies, and the member code of conduct. I understand that membership fees are non-refundable and that misuse of membership privileges may result in suspension or termination.
Signature: ___________________________
Date: ___ / ___ / 202_
Submit Completed Form To:
Northern Dunes Golf Club
665 Bruce Street, Hepworth, Ontario
Email: proshop@northerndunes.com
Phone: (519) 935-3000
Website: www.northerndunes.com
