Copy and paste this form and send to the secretary to apply for membership

DISLEY GOLF CLUB LIMITED

To the DISLEY GOLF CLUB LIMITED

I desire to become a member of the DISLEY GOLF CLUB LIMITED and I agree, if elected to become a member of the Club to be bound by the Memorandum and Articles of Association and Bye Laws of the Club.

Dated this .................................................. day of ............................................. 200................

Class of membership desired: ..........................................................................................................

Signature of Candidate ...................................................................................................................

Full name of Candidate (please print)

.....................................................................................................................................................

Date of Birth .................................................................................................................................

Address ........................................................................................................................................

.....................................................................................................................................................

.....................................................................................................................................................

Tel. No. .........................................................................................................................................

Mobile ..........................................................................................................................................

E-mail ...........................................................................................................................................

Occupation ....................................................................................................................................

Other Golf Clubs (if any) ................................................................................................................

Where did you here about us...........................................................................................................

The above Candidate is personally known to us and is a suitable person to be

elected a member of the DISLEY GOLF CLUB LIMITED

Name of Proposer (Print) ................................................................................................................

Signed ..........................................................................................................................................

Name of Seconder (Print) ................................................................................................................

Signed ..........................................................................................................................................

It is necessary for the proposer and seconder to be Full Members of the Club

of not less than four years standing