Three Rivers Senior Golf Association

                       Membership/Guest Application Form

Instructions:  The information you provide here is solely for the use of the

association and is protected.  Even though you may have provided the

information before, this information is required EVERY year for continued

membership. Please PRINT information CLEARLY for #'s 1-6 and sign your form at #7. 

Be sure to sign your application.

(1)  Last Name____________________________________ First_________________________________

(2)  Address_____________________________________________________________________________

                              Street/PO Box                        City/Town                      Zip

(3)  Home Course_________________________________________________________

(4)  Phone ___________________________  E-Mail Address___________________________________________________

(5)  Member Since___________________  Date of Birth (Required) __________________________________________

(6)  2016 Team Playing Partners: #1_________________________________ #2_________________________________

    #3________________________________   #4______________________________  #5________________________________

(7)  " In order to be a member or guest of this association, I hereby agree to abide by all rules of the association and the game of golf at each tournament played."

_____________________________________          ______________________________

                     Signature                                                     Date

 (8)  Suggestions______________________________________________________________________________

______________________________________________________________________________________________

 For Official Association Use Only:

(9)  Date 2017 Dues Paid______________________

(10)   List of tournaments this guest has played:

          First_________________________________________ Date________________________

          Second______________________________________  Date________________________

          Third________________________________________  Date________________________