Membership Information

ROCKLEDGE GOLF CLUB - MEN’S CLUB
2012 MEMBERSHIP APPLICATION
Member Information (PLEASE PRINT CLEARLY)
Name: _____________________________________________________________________________________________
Street Address: _____________________________________________________________________________________________
Town: _______________________________________________________ State: _______ Zip Code: _______________
Home Phone # ___________________________________Alternate Phone # __________________________________________
Email Address _____________________________________________________________________________________________
(will only be used for Men’s Club or Pro Shop communications;-not shared with public or sponsors)
Membership Renewal (Town and Non Resident)
_____ Adult
_____ Junior (ages 14-17 as of 1/1/12)
_____ Full Time Student (ages 18-24 as of 1/1/12)
(Required) School: ____________________________________________________________________________________
OR
New Membership
GHIN # (if available): ____________________ Birth Date mo/yr: (Required)___________________
_____ Adult Town Resident
_____ Adult Non Resident
Sponsoring Member: (Required, if not being grandfathered)____________________________________________________
_____ Junior (ages 14-17 as of 1/1/12
_____Full Time Student (ages 18-24 as of 1/1/12)
(Required) School: ____________________________________________________________________________________
Annual Dues*: Adult $85 (includes CSGA/GHIN)
Junior & FT Student $15 (includes CSGA/GHIN)
* Checks only
Mail or deliver application with check, payable to ‘Rockledge Men’s Club’ to:
Rockledge Golf Club-Men’s Club
c/o Ray Cusick, Treasurer
289 South Main Street
West Hartford, CT 06107
Internal Use Only…………………………………………………………………………..……………………………………
PRO: ________ GHIN:_____________________ RGC #:___________ TREAS:______________MEMROCKLEDGE GOLF CLUB  -  MEN’S CLUB