Three Rivers Senior Golf Association

2019 Membership Form

Instructions:  The information you provide here is solely for the use of the association and is protected.  This information is required for continued or new membership. Please PRINT information CLEARLY. Be sure to sign your application.

2019 Membership Requirements: "AT LEAST 50 YEARS OLD, MEMBER OF THE ASSOCIATION LAST YEAR, MEMBER OF A GOLF COURSE THAT WE PLAY NOW, PAY ASSOCIATION DUES, COMPLETE ANNUAL MEMBERSHIP FORM." (Approved 2018)

(1)  Last Name_______________________________ First_________________________________ 

(2)  Street (PO Box) ___________________________  City ___________________   Zip ___________

 (3)  E-Mail* (Required for Captains) ____________________________________________

 (4)  Phone ______________________  (5) Home Course* (Required) _______________________

 (6)  Member Since________________  (7) Date of Birth* (Required) _______________________

 (8) Team Captain ______________________________________ 

 (9) 2019 Team Playing Partners: #1________________________ #2_______________________

 #3________________________   #4_________________________ #5______________________

(10)  " In order to be member of the association, I hereby agree to abide by all association rules and the game of golf at each tournament played and I certify that I meet the membership eligibility requirements for 2019."

_____________________________________          ______________________________

           Signature                                       Date

 For Association Use Only, Do Not Complete:

2019 Membership: Approved  _________  Not Approved _________  Date Dues Paid__________

Return form to an officer or mail to:  Dick Blankenship, 122 Red Oak Lane, Searcy, AR 72143