GCSAA - Affiliate Individual membership application

Affiliate Individual membership application

Affiliate Company membership application

Application instructions:

1. Fill out the form completely and legibly -- you can fill it out on screen and then print it.
2. After reading the code of ethics, sign and date the application where indicated.
3. Enclose check for a full year's dues ($320) or indicate credit card number.
4. Please allow up to 4-6 weeks for processing.

Important: No application will be considered without dues enclosed or valid credit card information.

Membership type:

Affiliate Individual - $320-- To qualify for Affiliate Individual membership, an applicant must be interested in golf course management and/or in the growing or production of fine turfgrass and who does not qualify for membership in any other classification. Affiliate Individual members shall have all the privileges of the Association, except that of voting and holding office.

Individual information:

Preferred mailing address:

Home Business

Name:

Home address:

City:

State:

Postal code:

Country:

U.S. Citizen?:

Yes No

Date of birth:

Home Phone number:

Email address:

Current employment information :

Business name:

Address:

City:

State:

Postal code:

Country:

Type of business:

Business phone number:

Business website:

Past employment information :

Company name:

Address:

City:

State:

Postal code:

Country:

Type of business:

Life insurance beneficiary:

All members (excluding non-U.S. citizens, and the following member classifications: Student, Affiliate Company, Technical Assistance Network and International Superintendent member) are automatically enrolled into the dues term life insurance group policy. This benefit is at no additional cost to you - GCSAA pays for this benefit.

Insurance enrollment information

Name of beneficiary:

(Please print the first and last names, e.g., "Mary Smith" not "Mrs. J. Smith" or "Mrs. John Smith.")

Relationship to member:

Applicant signature:

I hereby submit my application for membership in the Golf Course Superintendents Association of America and attach my dues for one year in advance. It is estimated that 8% of my membership dues will be used for advocating positions on government issues, as well as payment of dues term life insurance for all members, excluding non-US citizens, student, affiliate company, technical assistance network and International Superintendent members, and that a portion is therefore not tax deductible as a business expense. I have read and agree to abide by the GCSAA Code of Ethics. (Visit org to access a copy of the Code of Ethics.)

Signature:
___________________________________________________

For GCSAA Office Use Only:

___________________________

Date:
___________________________________________________

Method of payment:

VISA MasterCard American Express

Card No.:

Exp. Date:

Check or money order (U.S. dollars drawn on U.S. bank) to:
GCSAA, P.O. Box 219004, Kansas City, MO 64121-9004