Pine Knolls Ladies Golf Association

1100 Quail Hollow Road

Kernersville, NC 27284

2009 Golf Season

Application for Membership / Renewal

please print & fill out the following information

Name __________________________________

PKLGA Hdcp. No. __________

Address

___________________________________________________________________

City ___________________________________

State ______

Zip ___________

Phone ____________________

Email __________________________________

Club Affiliation _____________________________

CGA Hdcp. No. __________

                                        ( other than Pine Knolls )

If no club affiliation . . . . average score for last 10 rounds _________

Please check one of the following

_____ Membership Renewal . . . . . . . . . . . . . . . . . . . . . . . . . . .

$60.00 per year

_____ Membership Renewal ( after Jan. 31st ) . . . . . . . . . . . . . .

$65.00 per year

_____ New Membership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$60.00 per year

Total Amount Paid _______________________ Check No. _________

Please make checks payable to PKLGA

and mail to the address above.