OSIRIS COUNTRY CLUB, INC.
P. O. BOX 286
WALDEN, N. Y. 12586
Telephone Number 845-778-5309
Fax Number 845-778-4194

E-mail: osiriscc@hvc.rr.com

APPLICATION FOR MEMBERSHIP

APPLICANT'S NAME___________________________STREET ADDRESS_____________

CITY_________________________STATE________ZIP___________PHONE___________

OCCUPATION_________________________________EMPLOYER___________________

YEARS EMPLOYED____________________________BUSINESS PHONE______________
EMAIL ADDRESS_______________
CHECK MEMBERSHIP BEING APPLIED FOR:

_____FAMILY ______JUNIOR (Date of Birth)
_____HUSBAND AND WIFE ______SOCIAL
_____SINGLE

If the application is for either a Family or Husband & Wife, membership, list below name of spouse and children and ages of children.

NAME OF SPOUSE________________CHILDREN AND AGES___________________

Note: All memberships except Junior require initiation fee.

REFERENCE OF TWO EXISTING MEMBERS:

NAME________________________PHONE__________ NAME_________________PHONE_______

RECOMMENDED BY: NAME________________PHONE__________SIGNATURE________________

STATEMENT OF RESPONSIBILITIES: By submission and acceptance of this application, I obligate myself for the payment of the full amount of the dues and agree to all conditions therein. It is understood that all memberships are sustaining and in force until a written resignation is submitted to and accepted by the Osiris Board of Directors.
All applications prior to being considered by the Board of Directors are required to be posted on the Clubhouse bulletin board for general membership review for a period of two weeks. An interview of the applicant will be held by the Membership Committee prior to being acted upon by the Board of Directors.

Signature of Applicant________________________________Date_____________________________________

THIS SECTION FOR ADULT MEMBERS ONLY

1) Have you been a member of another Golf Club? Yes____ No____
If yes, where and when?____________________________________
If yes, what did you like most about the other club.______________
_________________________________________________________
What did you like the least?_________________________________
_________________________________________________________
What was your reason for leaving?___________________________
_________________________________________________________
2) Approximately how many rounds of golf do you play each year?_____ Do you have an established handicap? Yes_____ No_____
3) If yes, what association and GHIN#?____________________________
4) Would you be interested in any of the following at Osiris?
Club Handicap Tournaments Yes____ No ____
Men's or Ladies weekly leagues Yes ____ No ____
Youth program for your children or grandchildren Yes____ No ____

THIS SECTION FOR JUNIOR APPLICANTS ONLY

COMMITMENT OF PARENT OR GARDIAN
I, ____________________________ agree to be responsible for all charges incurred by the applicant in the Osiris Club house or Pro Shop. If for any reason, I wish to restrict these privileges, I realize that it is my responsibility to notify the Osiris in writing.
Signed _____________________________________
Relationship to Applicant ______________________

APPLICATION PROCESSING INFORMATION

Date Application Submitted_______________
Check number __________received with application for the amount of _____________
Interview Date __________
Interviewed By ___________________________________________________________
Date application presented to Board of Directions for Acceptance___________________
Approved by Board - Yes_____ No _____
Active Membership Yes_____ OR Waiting List Yes____ Number on list_______