Membership Application

Fill out the web form below, or download the PDF application. Please contact General Manager, Chris Bellamy, at 419-747-1556 ext. 3 or chris@westbrookcc.com to submit your application or ask any questions about membership. All membership applications must be approved by the Westbrook Country Club Board of Directors.

Download the Membership Application

Please complete all sections in full.
Name Prefix
Mr.   Mrs.   Ms.   Miss  
Are you a doctor?
Dr.
Marital Status
Single   Married   Other  
Your Name *
Date of Birth *
Home Address *
City *
State *
Zip *
County *
Home Phone *
Other Phone
Email *

Business Information
Company Name
Type of Business
Title
Length of Employment (years)
Business Address
Business City
Business State
Business Zip
Business Phone
Business Email

Spouse Information
Spouse Name Prefix
Mr.   Mrs.   Ms.  
Is your spouse a doctor?
Dr.
Spouse's Name
Spouse's Date of Birth
Spouse's Email
Spouse's Phone
Does your spouse golf?
Yes   No  

Dependent Information

(Please list all children under 25 and indicate gender.)
Dependent 1 Name
Dependent 1 Date of Birth
Dependent 1 Sex
Dependent 2 Name
Dependent 2 Date of Birth
Dependent 2 Sex
Dependent 3 Name
Dependent 3 Date of Birth
Dependent 3 Sex
How did you hear about Membership at Westbrook?
Please bill dues and capital contributions: *
Please set me up for the following Food and Beverage Minimum Program: *
Please send billing statements to: *
My home address
My business address
The email address below
If sending to email, enter email address here:
Please send all correspondence to:
My home address
My business address
Sponsored By (1) *
Sponsored By (2) *
Sponsored By (3) *
Membership Classification: Active
Membership Classification: Social

I hereby apply for membership in Westbrook Country Club and, if accepted, agree to abide by its Constitution, Rules, and Regulations. The applicant agrees and consents that Westbrook Country Club may obtain a credit report for the express purpose of pre-qualifying for an extension of credit. It is further agreed and understood that Westbrook Country Club is not making any implied or expressed commitment by taking this course of action.

It is further understood that Club privileges shall not begin until this application is submitted and approved by the Westbrook Country ClubBoard of Directors. Furthermore, the undersigned hereby agrees to pay for all dues, assessments and /or charges for food and service costs within 30 days, and further agrees to pay all costs, including reasonable attorney fees and expenses and court costs incurred in the cost of the indebtedness.

I understand that, should I resign, the balance of any amounts due the club for initiation fees, dues or charges shall be immediately due and payable.
I have read and agree to the above statements.
I agree