Your name has been submitted for possible consideration for membership. We ask that you provide information about yourself and your background. Completion of this form does not confer any rights to use of Club facilities or membership privileges nor does completion and submission of this form suggest or imply that it will be considered by any date certain or that it will be accepted.
Please answer all questions on this questionnaire. All information will be considered personal and confidential.
If yes, please complete the following section:
If married, please complete the following section:
If married, please complete the following section:
SOCIAL, PROFESSIONAL OR ATHLETIC (Please list all current affiliations and designate which are present and which are former memberships. Please indicate full name, address and period of membership)
Have you been proposed or do you intend to pursue membership in another private club in the area? If so, please identify:
If elected to membership by our club, will you continue to seek or retain membership in the club(s) listed above?
Have you previously applied for membership to Wellesley Country Club?
Have you ever been refused membership, suspended, expelled, or requested to withdraw a proposal for membership in a club or other organization?
Have you ever voluntarily withdrawn from consideration for membership at any club or organization?
Have you ever been convicted of a felony?
OTHER SERVICE, FRATERNAL, RELIGIOUS, PROFESSIONAL, CIVIC AND PUBLIC AFFILIATIONS (Past and Present)
(em)(Please indicate full name, address and period of affiliation)
CLUB ASSOCIATION
List the members of our club who are your Sponsors.
List other members of our club with whom you are personally acquainted (business contact only is not sufficient):
List the names of any relatives who are or have been members of our club:
We consent that any inquiries may be made of the persons and organizations listed above and of any other persons or organizations (including credit bureaus) as the Membership Committee, Board of Governors and Officers of the Wellesley Country Club deem necessary or appropriate and that they may communicate to each other any information thus obtained. We further hold them harmless and release them from any and all liability on account of any such investigation or inquiry and their ultimate acceptance or rejection of our membership application.
We understand that all members are bound by the Articles, Bylaws and Rules of Wellesley Country Club, as amended from time to time.
We understand that it is the Primary Sponsor’s responsibility to see that all requirements for proper consideration of our candidacy by the Membership Committee and the Board of Governors have been met. We further understand that all inquiries concerning our candidacy will be directed through one of our Sponsors.
We certify that the foregoing information is true, accurate and complete. We understand that any misrepresentation shall be cause for denial of further consideration or expulsion if discovered after our admission to membership.
