Owned and operated by Hasan Mansouri
P. O. Box 5185, Manama, Bahrain. Tel: (+973) 593 593. Fax: (+973) 593 751
E-mail: countryclub@hasanmansouri.com

MEMBERSHIP APPLICATION /RENEWAL FORM

PERSONAL DETAILS

Full Name: ............................    ............................     ..........................    Date of Birth: ......../......../........
                         (First)                                  (Middle)                                   (Last)                                               Day     Month  Year
Spouse's Name: ..........................    ..........................     .....................     Date of Birth: ......../......../........
                                 (First)                              (Middle)                            (Last)                                               Day     Month  Year
Employer: .......................................  Nationality: ............................   Position held: ................................
Marital Status:  Married   Single   Children: 1.................................... Date of Birth: ......../......../........
CPR # : .........................................     Children: 2 ................................... Date of Birth: ......../......../........
                                                           Children: 3 ................................... Date of Birth: ......../......../........
Flat/House # : ..............................................            P. O. Box: .............................................................
Bldg. # : .......................................................            Town:  ...................................................................
Road # :.......................................................             Country:  ...............................................................
Block # : ......................................................            Tel. Office: ....................   Fax: ..............................
Area # : ......................     Tel. Home: ............           E-mail: ...................................................................
How do you hear of the club: ...............................................................................................................

Membership category: Full      Sports only    Other: ....................................... (check the facilities)
Membership Status:     Family    Couple        Single         Membership start date: ......../......../........
Duration: ..........................................                                     Membership expiry date: ........./......../........
Previous Membership Number (when renewing only): .........................     Members since: ......../......../........

I/We agree to abide by the Country Club's rule and regulations.
I enclose my cheque for ...........................................       ...................................................  made payable to The Country Club OR authorize you to debit my   Access     Visa    Amex     Diners account for the sum of BD ....................................... My Card number is .............................. Card expiry date :........./......../.......
Name: ........................................................     Signature: ................................     Date:  ........./......../.......

Approved ...........................   Waitlist ..................................        Committee review ................................
Date received : ........./......../....... Date processed : ........./......../....... Date computerized : ........./......../.......
Fee paid : .......................................       Receipt # & date : ........../......../.......