MEMBER NAME:____________________________________________

ADDRESS:______________________________________________________________

CITY: ________________________________   ST:_________    ZIP:_______________

HOME PHONE:___________________________________

WORK PHONE:___________________________________

CELL PHONE:____________________________________

EMAIL ADDRESS:_________________________________

MGA HANDICAP (Y/N)________GHIN#________________CLUB#_________________

SPOUSE INFO:

NAME:_____________________________________________________________________

MGA HANDICAP (Y/N)________GHIN#________________CLUB#_________________

JUNIOR INFO  (MUST BE 18 OR YOUNGER)

CURRENT MGA

NAME(s):

DATE OF BIRTH

HANDICAP GHIN #

_____________________________________________      ___________________

_____________________________________________      ___________________

2007

MEMBERSHIP CATEGORIES

MEMBERSHIP

SAVE 5%

SPOUSE

SAVE 5%

TYPES

FEES

PAY BY 12/31/06

HALF FEE

PAY BY 12/31/06

TOTAL AMOUNT DUE

FULL*

$1,100.00

$1,045.00

$1,650.00

$1,567.50

$

FULL SENIOR*

$950.00

$902.50

$1,375.00

$1,306.25

$

WEEKDAY*

$850.00

$807.50

$1,275.00

$1,211.25

$

WEEKDAY SENIOR*

$750.00

$712.50

$1,125.00

$1,068.75

$

JUNIOR*

$300.00

N/A

$

DRIVING RANGE

$300.00

N/A

$

INNER CLUB

$45.00

N/A

$

*THESE MEMBERS CAN ADD A DRIVING RANGE MEMBERSHIP FOR JUST $150.00

$

PAYMENT METHOD

AMT. RECEIVED

CHECK:______  MC/VISA/DISCOVER:______ CASH:______

$

MC/VISA/DISCOVER #______________________________________EXP.DATE:______________

SIGNATURE OF CARDHOLDER:_______________________________________________

PLEASE MAKE ALL CHECKS PAYABLE TO:

Rowley Country Club - to P.O. Box 751 Rowley,  MA  01969

Mail to 235 Dodge Road Rowley Ma 01969