CENTRAL NEBR SENIOR GOLF ASSOCIATION

MEMBERSHIP APPLICATION FORM

PRINT NAME:____________________________________________________________

ADDRESS________________________________________________________________

CITY________________________________ STATE___________ ZIP________________

BEST PHONE # _________________________

GHIN CARD NO.__________________________      18 HOLE HDCP (or best estimate) ___________

DATE OF BIRTH___________________SIGNATURE___________________________________

                (must be 50 or older sometime during the current year)

DUES: $15.00 --- include check payable to “Central Nebraska Senior Golf Assn”

Return to:         FA “Andy” Anderson, 6 Mallard Beach, Dr 19b, Johnson Lake, NE  68937

308-325-2035             e-mail:  lakeway@charter.net

Note:  Join anytime; BUT, must be received before March 1^st, to be included in directory.

Click Print at the very bottom of the page to print the application out.