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Women’s Maine State Golf Association
Individual Member Application
(For former members who have an established "prepay" account with an apporpriate balance.)
Requirements: Applicant must be a member of a golf club that is a member of WMSGA and must have
an active GHIN handicap at that golf club. Individual annual dues are $35.
Year: _______
Club Name: _____________________________________________________________
Name: __________________________________________________________________
Birth Date: ______________ Email Address: _________________________________
Phone #1: _________________________ Phone #2: ____________________________
Mailing Address: _________________________________________________________
City: ____________________________________State: _____ Zip: ______________
GHIN #: ________________________
(7-digit number)
Type of Membership: Regular _____ Supporting* _____ Junior** _____
Payment Type: Check ____ or Deduct from Prepay Account*** _____
*A supporting member is any person, business or corporation that desires to be a non-competitive supporting member of the association.
** A junior member is 18 years of age or younger. The membership fee for junior is waived. (A junior loses her eligibility after
September 1 of the year following her graduation from high school.)
***Only available if you have an established Prepay account with an appropriate balance
________________________________________________________________________________________
As a WMSGA member, I agree to hold the WMSGA, its agents and servants harmless and free from all claims, demands, and liabilities
originating from any loss or damage I may suffer in connection with any tournament I enter.
_____________________________ ________________________________
Signature of Applicant Name of Club Representative
Please submit your application with a check for $35 made out to WMSGA to:
Jean Young
PO Box 3628
Brewer, ME 04412
________________________________________________________________________________________
Office Use Only:
Date Rec’d _____________ Check # ________
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