Member Profile | Fairfield Golf & Country Club - Fairfield, Iowa

Golf
Dining
Event Calendar
Pool
About Us
Contact
Join the Club

Select Page

Member Profile

In order to know you better, we ask you to provide the following information about yourself and your background.

Personal Info

Primary Member Name (First + Last):(Required)

First Last

Membership Type (Choose One):(Required)

Join Date:

How long have you been a continuous member?

Home Address:(Required)

Street Address City State ZIP Code

How Long Have You Lived at the Above Address?:

Email Address:(Required)

Date of Birth(Required)

MM slash DD slash YYYY

Employment:

Employer:(Required)

Type of Business:(Required)

Employer Phone:

Employer Address:

Street Address City State ZIP Code

Occupation / Title:

Length of Employment:

Do You Have a Spouse or Spousal Equivalent?(Required)

Yes

No

Spouse Info:

Spouse Name?:

Spouse Email:

Spouse Employer Info:

Spouse Employer:

Spouse Employer Phone:

Spouse Employer Address:

City State ZIP Code

Spouse Occupation / Title:

Spouse Length of Employment:

Children (In school & unmarried)?

List Name(s) + Date of Birth

Your Education

Where Did You Attend High School

School:

Date:

Where Did You Attend College? (Click the + button to add a new row)

College:

Degree:

Date:

Postgraduate? (Click the + button to add a new row)

School:

Degree:

Date:

Spouse's Education:

Where Did Spouse Attend High School

School:

Degree:

Date:

Where Did Spouse Attend College? (Click the + button to add a new row)

College:

Degree:

Date:

Spouse Postgraduate? (Click the + button to add a new row)

School:

Degree:

Date:

Activity Preferences:

Put a number (1-5) next to each of these activities in order of preference (1 = most important to you).

Golf

Swimming

Dining Facilities

Social Activities

Special Activities

This field is hidden when viewing the form

Hidden

Interests & Affiliations

Affiliations:(Required)

Please list affiliations with other social, service, fraternal and professional organizations of which you or your spouse/spousal equivalent are now or have been a member:

Have You Ever Been on the Club Board or an Officer of the Club?(Required)

If So, Please Give Dates and Positions Held:

Reasons for Joining the Club:(Required)

(e.g. Golf & social opportunities with friends)

Would you be willing to volunteer your time to assist the club? If so, check which area interests you?

Golf

Pool

Kitchen/Front of House

Facilities

Membership

Social

Finance

Authorization / Acknowledgement

Consent:(Required)

I hereby authorize Fairfield Golf and Country Club to keep a photo copy of my driver’s license on file as part of my profile records. I certify that, to the best of my knowledge, the foregoing information is correct. I also agree to abide by the bylaws, rules and policies of the club as set forth by the membership and the Board of Directors.

Digital Signature:(Required)

Printing your First Name + Middle Initial + Last Name will act as your digital signature.

Date:(Required)

MM slash DD slash YYYY

Δ

Stay in the Loop!

Generally, Facebook is the best place to follow and share events and photos for the club. Follow us there

* indicates required

First Name

Last Name

Email Address *

Please Email Us if You Have:

Pictures to share on the site
Questions or comments
Events to add to the calendar

Send us an email >

Facebook

Copyright © Fairfield Golf & Country Club