e-mail: quinnatissetcc@charter.net


Return with $120.00 Application fee to:
Quinnatisset Country Club
Membership Committee
P.O. Box 401
Thompson, CT 06277


Date:________________________________________

Name:_______________________________________

Date of Birth:_________________________________

Spouse's Name (If Married)______________________

No. of Children:_______________________________

Residence:____________________________________

Telephone:____________________________________

Send Mail to:__________________________________

Telephone:____________________________________

Occupation:___________________________________

Email Address:_________________________________

Proposed By:___________________________________
                           (Current Member)

Seconded By:___________________________________
                           (Current Member)

Type of Membership Requesting:

( ) Single

( ) Family

( ) Junior

Applicant's Signature:____________________________________________