MEMBERSHIP APPLICATION

GLENLAKES MENS’ GOLF ASSOCIATION

Date ______

Name ________________________________  Date of Birth ____________

Wife’s name ___________________________________________________

Local Address _________________________________________________

City _______________________________ State _______   Zip _________

Local Telephone # (s)  __________________________________________

E-Mail Address _______________________________________________

Permanent Address ____________________________________________

City ____________________________State ___________Zip _________

Telephone #(s) ________________________  E-mail _________________

Amount Enclosed  _______________Cash _____________Check ______

Dues are $20.00

Make checks payable to : Glenlakes M.G.A

Please pay handicap fee at the Pro Shop