Request for Membership Information Form

CONTACT INFORMATION

First Name:

Last Name:

City:

State:

Postal Code:

HOW SHOULD WE CONTACT YOU?

Home Phone:

Cell Phone:

Email:

Best Time to Contact:

INFORMATION REQUESTED

How did you hear about us?

Word of Mouth	Used Facilities as a Guest
Family Member is a Member	Walk-In
www.kenwoodcc.net	Other - Please explain in comment box
Attended an Event/Golf Outing as a Guest	Social Media (Facebook/Instagram)

Please provide details here:

Please check your areas of interest:

ADDITIONAL INFORMATION

Comments or Additional Information: