Membership Golf Application 2023 Golf Memberships Name(Required) First Last Name (2nd Person) First Last Phone(Required)Phone (2nd Person)Email(Required) Email (2nd Person) Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Date of BirthMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Date of Birth (2nd Person)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Credit Card(Required) Expiry(Required) CVC(Required) Consent Please check here to provide your consent to receive emails from Brockville Country Club.All Membership Dues & Packages are payable by Cheque / Debit / Credit CardChoose Your Desired Package(Required) Adult Full Playing Member ($2,420 + $250 Capital Assessment, $60 House Fee, $30 Golf Activity Fee, $9 Hole in One Fee, $40 Golf Canada Fee) Senior 75+ (member of club for 10+ years)($2,200 Membership, + $250 Capital Assessment, $60 House fee, $30 Golf Activity Fee, $9 Hole in One Fee, $40 Golf Canada Fee) Couple A ($4,400n Membership, + $500 Capital Assessment, $120 House Fee, $60 Golf Activity Fee, $18 Hole in One Fee, $80 Golf Canada Fee ) Couple B / Spouse after 3pm ($3,650 + $500 Capital Assessment fee + $120 House Fee, +$60 Golf Activity Fee, $18 Hole in One Fee, $80 Golf Canada Fee ) Senior Couples 75+ ($4,125 Membership, + $240 Capital Assessment, $60 Golf Activity Fee, $120 House fee, $18 Hole in One Fee, $80 Golf Canada Fee) Intermediate A 19-28yrs ($1000 Membership +$220 Capital Assessment, $60 House Fee, $30 Golf Activity Fee, $9 Hole in One Fee, $40 Golf Canada Fee) Intermediate B 29-39yrs ($1,350 Membership + $220 Capital Assessment fee, +$60 House Fee, $30 Golf Activity Fee, $9 Hole in One Fee, $40 Golf Canada Fee)) Junior (age 13-18) $500 Membership, + $30 Golf Activity Fee, $30 Golf Canada Fee Novice (age 8-12) $350 Membership New Member Welcome Package (Try before you buy package) Includes 5 rounds of golf, $250 plus HST Out of Town membership (OTM) 20 Rounds of Golf $1000 plus HST, + Golf Capital Fee $250, Activity Fee $30, House Fee $60, Golf Canada $40, Hole in One $9 Platinum 75+ 9 Hole Membership ($1350 +Golf Capital Assessment $250 Golf Activity Fee $30 House Capital Fee $60 Hole in One Fee $9 Golf Canada Fee $40) After 2pm Membership ($1500 +Golf Capital Fee $250 Golf Activity Fee $30 House Capital Fee $60 Hole in One Fee $9 Golf Canada Fee $40) Family Member Novice (6-12) $220 Family Member Junior (13-18) $299 Seasonal Cart Packages Seasonal Cart Seat Package Individual $700 Seasonal Cart Package Couple $1400 Storage Options: Please contact Adam Miller for detailsPayment Options(Required) PAY IN FULL HST Price: $ 0.00 CAD Total CAPTCHAClick "Submit" below to authorize payments and agree that Brockville CC will not be responsible for lost, damaged or stolen belongings stored at the club. You are also acknowledging that power cart use is at your own risk and that any damages caused by negligence to the rental cart or the golf course will be your financial responsibility to repair. Please note that if you cancel your membership during the golf season a $250 admin fee will be charged and By clicking SUBMIT you are confirming you are aware of the $300 Food Minimum for all golfing members Δ
