Birch Run Golf Club

2018 Membership Application

Memberís Name:____________________________________________________________

Spouseís Name:_____________________________________________________________

Address:_______________________City:______________State:_____Zip Code:________

Home Phone Number:____-____-______

Cell Phone Number:____-____-______

Primary Email:________________________Secondary Email:________________________

Children who qualify under family membership (Immediate Family Only)(Full time student to age 22)

Name:__________________________________Age:________Birth Date:______________

Name:__________________________________Age:________Birth Date:______________

Name:__________________________________Age:________Birth Date:______________

Name:__________________________________Age:________Birth Date:______________

Please indicate Membership Category:

A. Single $610.00____

Single Early Pay (paid by 2/15/18) $565.00____

B. Family $820.00____

Family Early Pay(paid by 2/15/18) $770.00____

C. Student Membership $230.00____

INCLUDES USGA GHIN HANDICAP

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 calendar year 2018.)