Annual individual
dues are $30.
CLUB
NAME: ___________________________________________________________________
YOUR NAME: ___________________________________________________________________
DATE OF BIRTH: _____________ PHONE #1: _____________ PHONE #2: ______________
EMAIL ADDRESS: _______________________________________________________________
STREET/MAILING ADDRESS: _____________________________________________________
CITY _________________________ STATE _________________ ZIP _________________
GHIN
#____________________________
(7-digit number)
Type
of Membership: Regular______
Supporting* _______ Junior**______
*
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 juniors is waived.
(A junior loses her eligibility after September 1 of the year following her
graduation from high school.)
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 -- along with a check for $30 made out to WMSGA -- to...
Jean
Young
PO Box
848
Brewer, ME 04412
OFFICE
USE ONLY:
Date
Rec’d___________________
Check # _______________________