Houlton Community Golf Club

2011 Membership Application

Name:________________________ Spouse’s Name:_____________

Address:______________________

______________________ Dependents: ________________

(Under 18) ________________

Telephone (Home): _____________

(Work): _____________

Email:_______________________________

Pay Early and Earn A Discount.

Membership Dues

Family Membership: $645.00 $ ______________________ (Get $30 Club Credit If Paid By May 15, 2011)

Single Membership: $400.00 $ ______________________ (Get $15 Club Credit If Paid By May 15, 2011)

Student Membership: $125.00 $ ______________________

Social Membership: $ 85.00 $ ______________________

Cart Fee $135.00 $ ______________________

Locker Rental $ 15.00 $ ______________________

Total Amount Due: $ ______________________

Minimum due ($100.00) by May 15

Balance Due $ ______________________

Please Note:

Minimum amount of $100.00 is due by May 15, 2011

All memberships must be paid in full prior to June 30, 2011.

Please complete this form and return it to:

HOULTON COMMUNITY GOLF CLUB

P.O. Box 948

HOULTON, MAINE 04730