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CCC Membership Application
Applicant Information
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Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Spouse (If applicable, otherwise write "N/A")
*
Your answer
Phone Number
*
Your answer
Have you ever been proposed for membership in this club before
*
Yes
No
If so, when and with what result?
Your answer
REFERENCES
Provide references of at least two (2) current members of the club.
Reference # 1
*
Your answer
Reference # 2
*
Your answer
Send payment to P.O. Box 118, the clubhouse (883 County Rd. 1350 N, Carmi, IL 62821)
Membership options are on the "Memberships" page on the website.
Enter the date and your initials below as your signature of application.
Date
*
MM
/
DD
/
YYYY
Initials
*
Your answer
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