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NEW MEMBER APPLICATION
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MEMBERSHIP RENEWAL
r CHANGE OF ADDRESS
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(PLEASE PRINT AND FILL OUT COMPLETELY!!!)
____________________________________
____________________________________
Name
Company/ Employer
____________________________________
____________________________________
Home Address
Business Address
____________________________________
____________________________________
City/State/Zip
City/State/Zip
Home Phone ( ____)___________________ Business Phone (
____ )_______________
Spouse's Name
___________________
Fax Number ( ____ )_______________
Membership # (If Renewing)______________ E-Mail
Address_____________________
Are you a GCSAA Member: Yes ___ No ____ Job Title
_________________________
Are you a Certified Golf Course Superintendent ______________ Number of Holes
____
Preferred Mailing Address: Home ______________ Business
______________
Years at Present Location ______________ Years as a Superintendent
______________
NOTE: Information given on this Application will be published in the annual NGCSA Resource Guide and Roster
I hereby make application/membership renewal in the Nebraska Golf Course Superintendents Association
and attach herewith my dues for one year in advance in the amount of:
A Professional Member is a Class A, AA, B, C, D, or E member
| r Professional Member (New Member Only) . . . . . . . . . . . . .
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$25.00 ___________
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| r Professional Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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$75.00 ___________
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| r Student Member. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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$10.00 ___________
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Corporate/Commercial Member (Each Person) . . . . . . . . |
$75.00 ___________
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Scholarship Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Donation
_________
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Total ___________
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Signature of Applicant
____________________________ Date________________
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Mail
To:
NGCSA
Larry Hergott Secy/Treas
3920 87th Street
Columbus, NE 68601
Bus: (402) 562-4274
Home: (402) 563-3905
Fax: (402) 563-1380
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