Membership Process

Membership subject to the stated application process.

Membership Application
NCR Country Club
4435 Dogwood Trail Dayton, Ohio 45429
Office: 937/299-3571

I wish to apply as a candidate for membership in NCR Country Club.

By completing this application, I represent and warrant to NCR Country Club
that the information submitted is true and accurate.

I agree to provide payment for the initiation fee and appropriate dues billed following
the completion of my membership process.

Please choose one membership option:

Golf
(age 40-71)

Young Executive
(under age 40)

Silver
(over age 72)

Social

Non-Resident

Applicant

First and Last Name:

Years of Residence in Dayton Area:

Birth Date:

Street Address:

City:

State:

Zip:

Email:

Cell Phone:

Profession / Occupation:

Employer:

Applicant's Spouse

First and Last Name:

Birth Date:

Cell Phone:

Email:

Profession / Occupation:

Employer:

Additional Information

I am, or have been, a member(s) in good standing in the following social clubs:

Clubs & Dates

Please list the name and date of birth of children under the age of 25 and living at home:

Please list any current NCR Country Club Members you may know:

Please write a short biography about you and your family (if applicable) :

NON-MEMBER PERSONAL REFERENCES
Personal References are required by the Board of Trustees for consideration

Reference 1

First Name:

Last Name:

Home Phone:

Business Phone:

Address:

City:

State:

Zip:

How long acquainted:

What is your association:

Reference 2

First Name:

Last Name:

Home Phone:

Business Phone:

Address:

City:

State:

Zip:

How long acquainted:

What is your association:

Reference 3

First Name:

Last Name:

Home Phone:

Business Phone:

Address:

City:

State:

Zip:

How long acquainted:

What is your association:

Completed application should be accompanied by letters of recommendation from
TWO (2) current members of NCR Country Club. A photo of the individuals listed on this application must also be submitted. Membership will not begin until all steps of the application process are complete. You may submit letters of recommendation and photos to Kerry Pool.

By submitting this application, you agree to abide by NCR Country Club's rules and regulations.
By submitting this application you are committing to the fiscal year, through April 1.
Memberships automatically renew each fiscal year unless specified in writing with a 30 day notice prior to April 1.

An automatic email replay will come when the application has successfully been submitted.