Birch Run Golf Club
2020 Membership Application
Member’s Name:____________________________________________________________
Spouse’s 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 2/15/20) $565.00____
B. Family $820.00____
Family Early Pay(paid by 2/15/20) $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 2020.)