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SJGA Individual Membership Application

First Name:

Last Name:


Gender: Male Female

Street Address:

City:

County:

State:

Zip Code:

Phone #:

Cell Phone #:

Email Address:

Home Club Name:

GHIN Handicap ID # (7 digits):

Type your name EXACTLY as it appears on your GHIN card:

Handicap Service and #(If not GHIN):

Handicap #:

Date of Birth (mm/dd/yy):

Emergency Phone #: