2024
Membership Application/Renewal
Last Name___________________________ First
Name_________________________
Company____________________________ Position or
Title______________________
Home Address___________________________________________________________
Business
Address_________________________________________________________
Business Telephone #______________________ Cell Phone
#_____________________
Email: __________________________________Send Mail
To: Home (
)
Business ( )
Membership Classification-Please
mark the membership status that you are applying for
Superintendent (Class A or B) $75.00 ________
Assistant Superintendent (Class C) $45.00
________
Equipment Manager (EM) $45.00 ________
Course Employee (Spray Tech/Irrigation Tech) $45.00 ________
Student FREE
Affiliate (Owner or Employee of a
Company $75.00 ________
Serving the Golf Industry)
Voluntary Contribution for
Scholarship and
Research
$ ________
Total
$ ________
Are you a member of GCSAA ____ Card
# ________ Classification ____
Please make checks payable to MGCSA or pay with credit card below
Credit
Card (Visa or MC): #___________________________
Exp Date:_________ Vin:_______ Card Zip Code:_________
Signature of
Applicant_____________________________________ Date____________
Mail
this invoice with payment to:
MGCSA
Michiana GCSAA
9700 Deer Trail
Plymouth, Indiana 46563