MEMBERSHIP APPLICATION
   GREEN MEADOW COUNTRY CLUB
1700 Louisville Road,  Alcoa, TN   37701
                      (865) 982-8783        

   Full Name: ____________________________________________  Social Security # ________________

  Name you prefer to use:  ____________________________ Date of Birth ________________________

  Spouse’s Name: ___________________________________  Name you prefer to use _______________

  Date of Birth: _________________________    Social Security # _______________________________

  Home Address: ________________________________ City : _________________ Zip: _____________

  Occupation: _____________________________  Employer: ___________________________________

  Business Address: ______________________________ City __________________ Zip: ____________

  Home Phone: _____________Business Phone: _____________  Email Address____________________
    Please check  where you would like to have your statement mailed:  Home Address ____ Business Address ___
   Please list all dependent children under the age of 25:

  Name: ______________________________________  Date of Birth: ________________________________

  Name: ______________________________________  Date of Birth: ________________________________

  Name: ______________________________________  Date of Birth: ________________________________

     Member                     Initiation                    Entertainment                      Monthly                                 Total Due
Classification                    Fee                                 Tax                                   Fees                                     w/Application              
Resident                          $2,500.00                     $231.25                               $249.60                               $2,980.85
(with 1 yr agreement)      ($500.00)                      ($46.25)                                                                              ($795.85)

  Junior                               $  600.00                       $55.50                                $166.40                                  $821.90
(with 1 yr agreement)    ($300.00)                        ($27.75)                                                                             ($494.15)

  Social                                $  500.00                       $46.25                                $ 72.70                                    $618.95
(with 1 yr agreement)     ($250.00)                     ($23.13)                                                                               ($345.83)

Social House                     $  400.00                       $37.00                                $ 43.78                                  $480.78
(with 1 yr agreement)     ($200.00)                      ($18.50)                                                                             ($262.28)
                     All applications require the initiation fee plus tax and one month’s dues in advance.
                     A $75.00 PER QUARTER FOOD MINIMUM IS REQUIRED FOR ALL MEMBERS.

I hereby apply for _______________________ membership in Green Meadow Country Club, and if approved, I agree
to comply with all By-Laws, Rules and Regulations, and hold myself personally liable for all indebtedness incurred by
my membership to Green Meadow Country Club.  I also understand that I am obligated to Green Meadow Country Club
for the monthly dues for a period of one-year beginning __________________________.

Applicant Signature ______________________________________________    Date ___________________
 Sponsoring Member (1)  _______________________  Sponsoring Member (2)  ________________________