2017 Membership Application

Member’s Name:____________________________________________

Spouse’s Name:_____________________________________________

Address:____________________City:________________State:______

Home phone number:______-______-_________

Cell phone number:______-______-_________

Primary Email:_______________Secondary Email:_________________

Children who qualify under family membership (immediate family only, and full time student up to age 22)

Name:____________________________Age:______Birthdate:________

Please indicate Membership Category:

A. Single $595.00____

Single Early Pay (paid by 2/15/16) $550.00____

B. Family $795.00____

Family Early Pay (paid by 2/15/16) $745.00____

C. Student Membership $230.00____

Students must be enrolled full time and up to age 22.

Please make payment by check or money order to:

Birch Run Golf Club

4130 Birch Run Rd.

Allegany, NY 14706

Memberships must be paid in full prior to play.

Memberships will be for the 2017 golf season.