Name:_____________________________________ Phone: (Home)____________________
Address: ___________________________________ Phone: (Mobile) ___________________
Email Address___________________________________________
City: _____________________________________ Zip Code: _______________________
Date of Birth: _____________________________ Spouse’s Name: __________________
Junior Golfers in the family __________
Name: _____________________________________________________Age:_________
Name: _____________________________________________________Age:_________
Name: _____________________________________________________Age:_________
First Time Member________________ or Renewing Membership______________________
Regular Membership $60.00_______________
Paid: Check#______________ Cash______________ Date Paid: _______________________
Which Committees will you be interested in helping
Scholarship__________ Jr. Golf______________ Club House_____________
Fundraising__________ Good & Welfare_______ Special events___________
Tournaments_________ Family Outing__________ News Letter_____________
Children’s Christmas Party__________ Membership Drive___________
Your Average Score or Established HDCP______________
________________________________ __________________________________
Member Signature Officer Signature
Send completed application and payment to
Pan American Golf Association
P.O. Box 7614
Corpus Christi, Texas 78467-7614
Or Email Information
To CCPAGA Secretary
elongoria@aol.com
