Dues: Club Members: $135.00* Age 50 & Older             ——             Dues: Auxiliary Members: $160.00* Age 50 & Older                                                        

Name: (print legibly)________________________________________

Address: _______________________________________________

_____________________________________________________

City:_____________________

State:______  ZIP ___________

Phone:____________________

Home Club:____________________________GHIN#_________________
Email:______________________________________________________

Please make check payable to: COSWGA.  Return to: Your Club Representative (*check with Rep for fee)

Paid applications must be received by November 1 of the season year.
Current members will be given preference, then names will be taken in order from our waiting list.

_________Check enclosed

Club Rep Signature ___________________________________       Date __________