Pine City Country Club
        Order Form for Memberships and Gift Certificates
1. First Name:

2. Middle Initial:

3. Last Name:   

4. Address:


5. City:

6. State:

7. Zip Code:

8. Email Address: *required


9. Phone: *required

  (include area code)

10. 2018 Memberships (prices include the tax)
    > 2018 Early Membership Payment Special 
Pay early and save!
  *New Members*: Receive a $50 gift certificate for use on the driving range!
   Kids Play Free!: Immediate family members 17 and under play for FREE with an adults paid season membership

Check the box of the membership you would like to purchase
Single Golf Season Membership
Couple Season Membership
Junior Season Membership***
College Student Season Membership**
Young Adult / Senior Single Season Membership
Young Adult Couple / Senior Couple Season Membership
  Power Carts:
Single Seat
Couple Power Cart
  Driving Range:
Driving Range Pass Single
Driving Range Pass Couple
Locker - $32.21

Please be sure to fill out the below information for Membership Purchases:

  First Member Name: Renewing   New
  Additional Member: Renewing   New
  Additional Member: Renewing   New
  Additional Member: Renewing   New

11. Gift Certificates:  (please type the amount you would like to purchase into the box below):

Gift Certificate #1:


Gift Certificate #2:


Gift Certificate #3:



12. Payment  (This is a secure site.)

Type of Card:

Your Name as it Appears on your Credit Card:  

Credit Card Number: 

  *Please double check your #

3 Digit security code found on the back of the card: 
Expiration date:


Street address your credit card bill is sent to:

click here if same as above

Total Amount to bill to your credit card:



Your payment will be processed and order mailed within 5 business days.

(Note: There may be up to a 15 second delay for encryption before confirmation.)