Dues Application/Renewal

      Membership Application 2017

Last Name___________________________  First Name_________________________

Company____________________________ Position or Title______________________

Home Address___________________________________________________________

Business Address_________________________________________________________

Contact Telephone #______________________ Cell Phone #_____________________

Email: __________________________________

Send Mail To:          Home (   )              Business (   )

Membership Classification-Please mark the membership status that you are applying for

Superintendent Member                                                                     $60.00 ________
Class C (Assistants)                                                                           $35.00 ________
Class D(Course Employee)                                                                $35.00 ________
Affiliate (Owner or Employee of a Company                                    $60.00 ________
                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: ________________

Signature of Applicant_____________________________________ Date____________
Mail this invoice with payment to:

MGCSA
Michiana GCSAA
9700 Deer Trail
Plymouth, Indiana 46563