Membership Application

Once you have spoken with our Membership team or had a tour of the facilities, please fill out the form below and submit. Once your application has been reviewed, a Membership team member will contact you.

Please note the following:
- Co-Applicant must be a spouse or significant other of the Applicant.
- Dependent children must be under 25 years of age.

Name:*
Title Option:	Dr.
DOB:*	Date and timeCalendarToday
Desired Membership Category:*	Full Junior (40 & Under) Junior II (30 & Under) Social Non-Resident
E-mail:*
Home Address:*
Apartment or Suite:
City, State:*
U.S. ZIP code:*
Mailing Address:	(If different from Home Address)
Apartment or Suite:
City, State:
U.S. ZIP code:
How would you like to receive your statement?:*	Emailed Mailed Both
Cell Phone Number:*	()-First three digitsSecond three digitsLast four digits
Home Phone:	()-First three digitsSecond three digitsLast four digits
Applicant Sex:*	Male Female
Marital Status:*	Single Married Significant Other
List Dependent Children:	Name, DOB, Gender for dependents
Applicant Company Name:
Applicant Company Title:
Applicant Company phone number:	()-First three digitsSecond three digitsLast four digits
Applicant Company Street Address:
Applicant Company City, State:
Applicant Company ZIP code:
Co-Applicant Name:
Co-Applicant Title Option:	Dr.
Co-Applicant DOB:	Date and timeCalendarToday
Co-Applicant E-mail:
Co-Applicant Cell Phone :	()-First three digitsSecond three digitsLast four digits
Co-Applicant Sex:	Male Female
Co-Applicant Company Name:
Co-Applicant Company Title:
Co-Applicant Company phone number:	()-First three digitsSecond three digitsLast four digits
Have you ever been a Rock Barn Member?:	Yes No
If yes, provide dates and reason for resignation:
Select Areas of Interest:	Ladies' Golf Men's Golf Tennis Pickleball Fitness Spa at Rock Barn Aquatic Center Real Estate Dining Lodging Event Venues Wine Society Book Club
Signature:*	Type Full Name
Today's Date:*	Date and timeCalendarToday
Security code:	Enter security code: