Membership Application

2010 MEMBERSHIP APPLICATION

WWPLGA CLUB MEMBER--$35.00

*WWPLGA INDIVIDUAL MEMBER (SINGLE PERSON)--$15.00

Make check payable to WWPLGA: Please remit to:

Geri Lee-Petersen

4829 Charles Street

Racine, WI 53402

CLUB and Delagate Information:

NAME of CLUB__________________________________________________________

ADDRESS of CLUB______________________________________________________

CITY___________________________________STATE_________ZIP_____________

PHONE_______________________________________________________________

E-MAIL ADDRESS of CLUB_______________________________________________

NAME of DELAGATE____________________________________________________

ADDRESS of DELAGATE_________________________________________________

CITY___________________________________STATE_________ZIP_____________

PHONE_______________________________________________________________

E-MAIL ADDRESS of DELAGATE__________________________________________

INDIVIDUAL INFORMATION:

NAME________________________________________________________________

ADDRESS_____________________________________________________________

CITY___________________________________STATE_________ZIP_____________

PHONE_______________________________________________________________

E-MAIL ADDRESS______________________________________________________

CLUB AFFILIATION_____________________________________________________

TOTAL:______________

PAYABLE: Before tournament entry is accepted.

*Individual golfers who want to play in tournaments but do not belong to a WWPLGA club.