Membership Application Form

Nominee Information

Present Occupation (If retired, please list most recent occupation)

Family Information

Please list all dependent children of nominee and spouse/significant other. A dependent child is defined as a child of a Member who has not attained the age of twenty-four (24) years old and is currently unmarried.

Additional Information

Please list any offices held or committee activities completed while a member of the above clubs.

What civic and charitable organizations are you and/or your spouse/significant other involved with currently?

Have you or your spouse/significant other ever been a member of Farmington Country Club?

If so, please state the name in which the membership was held, whether it was Resident or National, and list the approximate dates.

Do you or your spouse/significant other have a relative who is now a member of Farmington Country Club?

If so, please list their name(s) and relationship

Please list the names of Farmington Country Club members who are personally acquainted with you.

Has a nomination of you or your spouse/significant other for membership in any club been declined or withdrawn?

Have you or your spouse/significant other ever been suspended or otherwise disciplined at any club of which you are or have been a member?

Have you or your spouse/significant other ever pleaded guilty to or been convicted of a crime, with the exception of a traffic misdemeanor, or had any professional license suspended or revoked, or surrendered any professional license while under investigation?

Have you or your spouse/significant other ever declared personal bankruptcy or been involved as a principal in a business that declared bankruptcy?

If you answered yes to any of the above questions, please provide details in a separate letter.

Proposer And Seconder Information