Membership Inquiry Form

First Name:*

Last Name:*

Email Address:*

Telephone Number:*

()-First three digitsSecond three digitsLast four digits

Alternate Telephone Number:

()-First three digitsSecond three digitsLast four digits

How would you like to be contacted?:

By email
By phone

Gender:*

Male
Female

Which membership category would you like to receive information on:

SWA - Social Waiting Active (Ages 36+)
Senior (Ages 65+)
Intermediate 3 (Ages 30-35
Intermediate 2 (Ages 26-29)
Intermediate 1 (Ages 19-25)
Junior (Ages 10-18)

Additional Comments or Questions:

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Uplands Golf Club
3300 Cadboro Bay Road
Victoria, BC V8R 5K5

Phone: 250.592.7313

Pro Shop: 250.592.1818

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