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MEMBERSHIP APPLICATION for Khedive Golf Club
Date: _________________________
__________________________ _________________________ ________ _______ Last Name First Name Initial Suffix ________________________________ _______________________ _____ _________ Address City State ZIP _______________________________ _____________________________ Nickname Spouse’s Name _______________________________ _____________________________ Phone E-mail Address Shriner: Yes / No If No, Guest of Noble _____________________________
This application should be submitted, along with your dues of $10.00, to the Club Secretary (if a Guest, via your sponsor). An additional $1.00 should be submitted if you desire "Hole-in-One" insurance. Please note: The information submitted by you is for the exclusive use of the Club Secretary in the execution of his duties. No dissemination to an outside entity is authorized and will not be condoned.
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