KCC Membership Nomination-Pro Shop 2025/2026

1
Full Name * This field is required.Please enter First Name and Last Name
Firstname Lastname
2
Date of Birth* This field is required.Day Month Year ie 01/01/2000
Date
Day
Month
Year
3
Gender* This field is required.
Please Select
Please Select
Male
Female
4
Residential address* This field is required.Please enter your full residential address and not mailing address
5
Postal address
6
Telephone/Mobile* This field is required.
7
Occupation
8
Email Address* This field is required.
example@example.com
9
IDENTIFICATION

Place your ID on a flat surface with a white background.

Select the TAKE PHOTO option below then using your device back camera, please take a legible photo of your license. Or you may select the option ADD FILE and attach a jpeg or pdf of your ID.
10
Take PhotoPlace ID on a flat surface with white background. Select Take Photo below or Select Next to Upload a File.
11
File Upload
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Browse Files
Cancelof
12
PLEASE NOTE IF YOU CHOOSE TO LEAVE ANY OF THE FOLLOWING BLANK YOUR APPLICATION MAY BE REJECTED.
13
Have you ever been banned or excluded from any club in the NT?* This field is required.
YES
NO
14
Have you ever been placed on a prohibition order preventing you from entering licensed premises?* This field is required.
YES
NO
15
Have you ever been placed any court orders preventing you from purchasing alcohol?* This field is required.
YES
NO
16
I hereby agree to abide by the rules and Consitution of the Katherine Country Club.

I also agree to the KCC Patron Code of Conduct.

Copy of the Constitution is available upon request.

Membership is temporary until approved by the Board.
17
PLEASE MARK THE APPROPRIATE MEMBERSHIP BOX.

Pensioners (with a valid NT Pensioner/Carer Card) are 50% of the normal fee.

All membership fees include GST
18
PLEASE MARK APPROPRIATE MEMBERSHIP BOX.* This field is required.
MID WEEK GOLF $350
SOCIAL 1 YEAR $20
FULL GOLF $550
SOCIAL 2 YEARS $25
BOWLS MEMBER $80
SOCIAL 3 YEARS $30
JUNIOR BOWLS $17
19
Full Golf Membership includes a free Club Polo Shirt. Please specify your size below.

NOTE: Small fit I consider adding 1 size.
20
Mens (Unisex) XS to 7XL
Please Select
Please Select
XS
S
M
L
XL
2XL
3XL
4XL
5XL
6XL
7XL
21
Ladies (Fitted) 8 to 26
Please Select
Please Select
8
10
12
14
16
18
20
22
24
26
22
Date
Date
Day
Month
Year
23
Signature* This field is required.
24
PLEASE SELECT + TAB NEXT TO THE MEMBERSHIP TYPE.

THEN SELECT THE MONTH OF TODAYS DATE.

THIS WILL APLLY THE PRO RATA MONTHLY DISCOUNT FOR THOSE JOINING AFTER APRIL.

ie Full Golf Membership "Month Joined" August
25
Membership Category* This field is required.
prevnext( X )
My Bag
0
My Bag
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
ORDER SUMMARY
GSTAUD
SubtotalAUD
Total costAUD
Full Golf Membership
Full Golf Membership
Edit
Back
April
April
May
June
July
August
September
October
November
December
January
February
March
Month Joined
Mid Week Golf Membership
Mid Week Golf Membership
Edit
Back
April
April
May
June
July
August
September
October
November
December
January
February
March
Month Joined
Subtotal:
Total cost
Credit Card
First Name
Last Name
26
Nominated by
27
Membership No
28
Membership category
29
Image Field
30
Seconded by
31
Membership No
32
Membership category
33
Image Field
Should be Empty:

IDENTIFICATION

Place your ID on a flat surface with a white background.

Select the TAKE PHOTO option below then using your device back camera, please take a legible photo of your license. Or you may select the option ADD FILE and attach a jpeg or pdf of your ID.

PLEASE NOTE IF YOU CHOOSE TO LEAVE ANY OF THE FOLLOWING BLANK YOUR APPLICATION MAY BE REJECTED.

I hereby agree to abide by the rules and Consitution of the Katherine Country Club.

I also agree to the KCC Patron Code of Conduct.

Copy of the Constitution is available upon request.

Membership is temporary until approved by the Board.

PLEASE MARK THE APPROPRIATE MEMBERSHIP BOX.

PLEASE SELECT + TAB NEXT TO THE MEMBERSHIP TYPE.

THEN SELECT THE MONTH OF TODAYS DATE.

THIS WILL APLLY THE PRO RATA MONTHLY DISCOUNT FOR THOSE JOINING AFTER APRIL.

ie Full Golf Membership "Month Joined" August