Name: ______________________ _________________________
Home Club: ____________________________
Handicap service (circle): GHIN Golf Services Group
Handicap number (fill in one):
GHIN: __ __ __ __ __ __ __
GSG: __ __ __ __ __ __ __ __ __ __
Current Handicap Index (must not exceed 22.0): ____
Approximate number of rounds played in the past 12 months: ____
Date of birth: ________________ _____ ______
Home address:
_____________________________________________________
_____________________________________________________
E-mail address: ______________________________________________
Home phone number: (_____) _____ – ______________________
Cell phone number: (_____) _____ – ______________________
My signature below certifies that I post scores correctly, following all acceptable rounds:
______________________________________________________
Mail this form with a check for the $10 membership fee to:
Linda Miller
48 Cherry Street
Mount Holly, NJ 08060
