2019 DCC Membership Application

Applicant Information
Name
Date of Birth
Home Phone
Email Address
Home Address
Employer
Position
Cell Phone
Business Address
Please send member statements to:
Previous or current club affiliations
I am interested in receiving email notifications regarding:
Spouse
Date of Birth
Second Email
Child 1
Date of Birth
Child 2
Date of Birth
Child 3
Date of Birth
Describe your expectations of membership at the DuPont Country Club. Why are you interested in joining? Please include any play groups, club activities, or dining offerings in which you and your family are interested in joining.
Individual
Family
Junior
Additional Options (to be marked in addition to above items)
Sponsor Information
Sponsor’s Name
Member Number
Sponsor’s level of membership
Years as a member
Acceptance of Rules
(12, 24, or 36) months
Primary Candidate’s Signature
Date:
Additional Candidate’s Signature
Date:
Fitness Center Release Form
Signature
Name
Date:
Credit Card Authorization Form
Name as listed on card:
Credit Card type:
Credit Card #:
Expiration Date:
Monthly Charges
Initiation Fee
I would you like to receive my monthly statement electronically by email
Signature
Date:
Name
Membership Descriptions

Click here to Download Membership Application