Name: ___________________ _____________________________
Handicap number (fill in one):
GHIN: __ __ __ __ __ __ __
GSG: __ __ __ __ __ __ __ __ __ __
Other: Name _____________________ Number: _____________________
Current Handicap Index (must not exceed 22.0 for men, 28.0 for women): ____
Home Club: _______________________
Approximate number of rounds played in the past 12 months: ____
Cell phone number: (_____) _____ – ______________________
Home phone number: (_____) _____ – ______________________
E-mail address: ______________________________________________
Date of birth: ________________ _____ _______
Month Date Year
Home address:
_____________________________________________________
_____________________________________________________
My signature below certifies that I post scores correctly, following all acceptable rounds:
______________________________________________________
Signature
Mail this form with a check for the $10 membership fee to:
Linda Miller
48 Cherry Street
Mount Holly, NJ 08060
