MOB 2017 Membership Form

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Membership Form

 Date: ___________________ Membership Year: 2017

 Membership Status – choose one

[ ] I am a new member.

[  ] I am renewing my current membership.  

[  ] I am a re-joining former member.


Billing preference -- choose one

[ ] Enclosed is $25 cash or check as payment made payable to "Men of Bentwater"  

[ ] Have Country Club bill my account for the amount of this year’s dues and yearly thereafter on my January/February Country Club statement. (preferred method)  

CC Member Number_____________ Signature:___________________________________

Member Information (please print)


 Mailing address:_______________________________________________Montgomery, TX 77356

 Telephone: (home)_______________________ Cell: _____________________

 E-Mail: __________________________________________

 Forward your completed membership form and your dues check (or selection of Country Club billing) to

Jerry Elder, Membership Chairman, 6 Westlyn Court Montgomery, TX 77356.

If you have any questions or comments, call Jerry at 936-597-6595 or e-mail Jerry at

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