Pine Knolls Men's Golf Association

P.O. Box 251    Kernersville, NC 27284

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Membership Application

2012 Golf Season

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Name ________________________________________  PKMGA Member # ________________

                                                                                                                                                                                                 (to be assigned)

Address _______________________________________________________________________

City ________________________________________________  State ______  Zip ___________

Phone _____________________  Cell ____________________  circle which to receive phone-tree messages

Email ______________________________________________________  for up-to date- email messages

Last Club Affiliation ________________________________  Member # _________  Hdcp. _____

                                                                     ( other than Pine Knolls )

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

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Please note: without a verifiable handicap, all members must have five (5) scores

posted from Pine Knolls Golf Course for eligibility in association tournaments.

Please indicate the tee's you'd prefer to play.

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_____ White

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_____ Gold ( Senior Tee's age 55 and above ) *

            * Note: Once gold tee's have been declared, you must remain on them for the entire 2012 season

Please check one of the following.

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_____ Annual Membership ( paid before Aug. 31st ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $65.00

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_____ Annual Membership ( after Aug. 31st ) . . . . . . . .  . . . . . . . . . . . . . . . . . . . . . . . . . $125.00

                 Includes:

                 ~ One (1) annual membership to the men's association.

                 ~ Company name on outside sponsor board for 2012.

                 ~ Company name / logo with hyperlink added to the association website for 2012.

                 ~ Members name, company name / logo on a hole sign that will be displayed for all our monthly tournaments in 2012.

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_____ Hole-in-One Contest (optional ) . . . . . . . . . . . . . . .  . . . . . . . . . . . . . . . . $10.00 (until won)

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Total Amount Paid ______________________________ Check No. __________________

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Please return application and check ( made payable to PKMGA )

to the Pine Knolls Pro Shop or mail to the above address.

Questions . . . Call the Pro Shop at 993-8300