Oak Park Club new member application

Please complete this form, print it, and then mail it to:

Oak Park Club
PO Box 32258
Raleigh, NC 27622-2258

Make checks payable to: Oak Park Club Inc.

Please check the box next to the desired membership type.
Add the membership dues to the initiation fee to calculate your total payment.

Invoices received after March 1 are subject to a $25 late fee

Full name(s):______________________________________________
Address:__________________________________________________
Phone (home) _____________________________________________
Phone (office)______________________________________________
Phone (cell)_______________________________________________
E-mail address_____________________________________________
If referral please list name: __________________________________

Children Living at Home:
(Use back of form if need to add more children)
Name:__________________________Sex:_____________ Birth Date:_________
Name:__________________________Sex:_____________ Birth Date:_________
Name:__________________________Sex:_____________ Birth Date:_________

Person(s) to Notify in Case of Emergency:
Name:___________________Phone#__________________
Name:___________________Phone#__________________

I understand that Oak Park Club Inc. operates primarily on the funds received from initiation fees and annual dues.  I also understand that the new initiation fee is a one-time fee. 
Dues must be paid annually and in full in order to remain active status and attend the club. 

I agree to the above statements and to pay the fees to activate my membership to Oak Park Club.

Signature:_________________________________Date:_____________________________