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Information submitted in this form to Essex Fells CC is confidential as applicable to the Membership Committee Processes and must be completed fully and truthfully. Applicant Information later found to be false or misleading may lead to resignation if deemed material by the Board of Trustees.
Please note the REQUIRED fields that MUST be completed.
Please enter the security code at the end of the form to enable the form to be submitted.
Member, Please complete the form for both you and the Significant Other Applicant. Submission indicates agreement to the EFCC Significant Other Policy, and Club's Rules, By-Laws, Policies, Procedures, Mission, Vision, Values, and Spirit.
Copies of this completed form will be signed after potential approval.
Contact the club with any questions:
Julie Peluso | Director of Member Relations | 973-226-3800 | x249
Significant Other Application Form
Member First and Last Name:
*
Marital Status:
*
Married
Divorced
Single
Widow/Widower
Other
Membership Change Type:
*
Adding as Significant Other
Adding as Spouse
Upgrading to Family
Other
Select all that apply
Member Number:
*
Significant Other First Name:
*
Hereafter, Significant Other = "SO"
SO Last Name:
*
SO Maiden Name:
if applicable
Significant Other Title:
*
Significant Other Middle Name:
Significant Other Suffix:
SO Marital Status:
*
Married
Divorced
Single
Widow/Widower
Other
SO Mailing Address:
*
need not match Member
SO City:
*
SO State:
*
SO Zip:
*
SO E-mail :
*
SO Date of Birth:
*
SO Employment:
*
U.S. phone number:
(
)
-
First three digits
Second three digits
Last four digits
SO Children to be included in the Membership:
please note name, DOB, cell, email, address
Security code:
Enter security code: