Please print out this
Membership Form and send it along with your check to the following address.
Your EAGA Membership Card,
EAGA Bag Tag, Financial Report and Membership Directory will be
mailed to you upon receipt of your dues.
Bob Buck
E.A.G.A
Annual Membership |
$ 15.00 |
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Life Membership |
$ 200.00 |
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Associate Membership (Non-amputee) |
$ 15.00 |
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Scholarship Fund Contribution |
$________ |
Annual Fund Contribution |
$________ |
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Total Enclosed (Make check payable to the E.A.G.A.) |
$________ |
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Your dues and contributions will
help carry on the rehabilitation work of the association through the medium
of golf and are tax deductible under section 501(c)(3) of the Internal
Revenue Code of 1986. Any questions about an EAGA membership, please call the
EAGA Office at 888-868-0992. |
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Name: _________________________________________ Birth date: ______________ Address: _________________________________________________________________ __________________________________________________________________________ E-mail Address: _______________________________ Home:( )_______________ Type Amputation: _____________________________ Bus:( )_________________ Veteran: ____ Y ____ N Spouse 1st Name: ________________________