Northern Dunes Golf Club
2027 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+)
☐ Intermediate (18–45)
☐ Couples (per person)
☐ Couples Twilight (per person)
☐ Twilight (after 2 pm)
☐ Junior (17 & under)
Discounts
☐ Discount for rounds played in 2026 (please specify amount): $ ____________
Optional Add-Ons (check all that apply)
☐ Power Cart (Single)
☐ Twilight Cart
☐ Couples Cart (per person)
☐ Couples Twilight Cart (per person)
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
