Membership Application

                                                                     WYOMING SENIOR GOLFERS' ASSOCIATION
                                                             
Application for Membership

                                                                               
Date _________________________________, 20______


       I hereby apply for membership in the Wyoming Senior Golfers' Association and agree to abide and be bound by the constitution,

       by-laws and rules of the Association now in force, or as hereafter changed or amended.
                                         (Must be at least 50 years old...a Wyoming Resident ... Have a valid GHIN #. )

   GHIN# _________________________  State__________________________

   Name (in full) ________________________________________________ Wife's first name ____________________________

   Date of Birth/Month __________________________  Day _________  Year ___________

   Occupation _______________________________________ Member of ____________________________________ Golf Club

   Business Address __________________________________ Residence Address _____________________________________

   Business Phone ___________________________________  Residence Phone ______________________________________

   e-mail address __________________________________________________________________________________________

   SIGNATURE OF APPLICANT _______________________________________________________________________________

                                                                                SEND APPLICATION TO
                                                                                        Dick Atkins
                                                                                        2921 Thomes Ave
                                                                                       Cheyenne, Wyoming 82001



               ANNUAL DUES ......................................................................... $40.00