Iam||y loteots wltb cbllJteo ooJet tbe oqe of 21 $630.00 $43.30 569S.

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Iam||y 3S loteots ooJet tbe oqe of J5 wltb cbllJteo ooJet tbe oqe of 21 $373.00 $40.23 561S.2S
Coup|e 8otb J5 tbto 69 yeots of oqe $600.00 $42.00 5642.00
Coup|e 3S 8otb ooJet tbe oqe of J5 $330.00 $38.30 5S88.S0
Coup|e 70 8otb 70 yeots of oqe ooJ olJet $330.00 $38.30 5S88.S0
S|ng|e J5 tbto 69 yeots of oqe $473.00 $33.23 5S08.2S
S|ng|e 3S uoJet tbe oqe of J5 $393.00 $27.63 5422.6S
S|ng|e 70 70 yeots of oqe ooJ olJet $393.00 $27.63 5422.6S
Iun|or 1bto n5 qtoJootloo sommet $123.00 $8.73 5133.7S
Co||ege Go|fer loll tlme stoJeot eotolleJ lo o colleqe/oolvetslty $130.00 $10.30 5160.S0
8us|ness 2 Colfets plos 20 oloe-bole qolf posses $790.00 $33.30 584S.30
!"#$%& ()*+ ,-./ 01.2" 3.&45 6, 74869: 18 ;<"%= .- ;4>< ?@)*+ 18 ;-"#6& ;4-#A B
C$1 3.&45 ?D"/1"-><67?>A 5">> 47756%415" !6>%.$9&A E
Go|f Car 1ra|| Iee (member owned go|f car) 5toteJ ot ot btooqbt oo to qolf cootse by membet $140.00 $9.80 5149.80
Go|f Car Secondary User AJJltloool oset of o ptlvote Colf cot (most be o cotteot membet) $140.00 $9.80 5149.80
Go|f Car Storage - Gas Colf cot stoteJ ot qolf cootse - qos poweteJ $110.00 $7.70 5117.70
Go|f Car Storage - L|ectr|c Colf cot stoteJ ot qolf cootse - bottety poweteJ $163.00 $11.33 5176.SS
Season Go|f Car ass - S|ng|e let petsoo - pet seot. 5ecooJ tlJet sobject to teotol tote $440.00 $30.80 5470.80
Season Go|f Car ass - Iam||y or Coup|e loll osoqe. Coest tlJet sobject to teotol tote $340.00 $37.80 5S77.80
C$1 3.&45 ., F.5, ;4- G"54&"# H"">
C$1 3.&45 ?41.2" D"/1"-><67 I6&< 47756%415" !6>%.$9&A J
3K30L ?M49$4-8 NO @PQR #"4#569" ,.- D"/1"-><67 !6>%.$9&A E
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Lxp|rat|on Date / /
3 D|g|t CSC code on back
Check one ___ VISA ___ MasterCard ___ D|scover
***lleose feel ftee to oot locloJe yoot cotJ oombet lf mollloq.
we wlll coll yoo fot o cotJ oombet lf yoo cboose.
lbooe oombet. ( ) -
Cred|t Card Charge Informat|on (|f app||cab|e)
ClLy
Pome hone ( )
Cell hone ( )
8uslness hone (lf appllcable) ( )
Lmall Address (lMC81An1!)
Lmall Address
Malllng Address SLreeL / C 8ox
kA1L + SALLS 1Ak = 1C1AL
AppllcanL's lull name Age as of 4/1/14
Spouse's lull name (lf appllcable) Age as of 4/1/14
Chlldren and Ages (lf appllcable)
|ease transfer 1C1AL from above and h|| out app||canon be|ow
7.3 Cash ulscounL C Membershlp lf pald by !anuary 6, 2014

kLkNCUS1IL GCLI CLU8
2014 Membersh|p and Go|f Car Usage kates
LAkL A 7.S MLM8LkSnI DISCCUN1 GCCD 1nkU IANUAk 6, 2014
1kANSILk IkCM A8CVL:

1ota| Due:


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Checks ayable Lo:

S"-9.$>T" F.5, ;5$1

lease send appllcauon and dues pmL Lo:

S"-9.$>T" F.5, ;5$1
@PU ;.$9&-8 ;5$1 !- CV
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