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_______________
Senior Membership $10.00_______________ (Must be at least 50 years old)
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
