Name__________________________________________________________________________

I'm a Member of_______________________________________________________________Golf Club/Country Club

Golf Club Phone Number & Address______________________________________________

______________________________________________________________________________

My Birthdate_____________________________________________

Spouse's First Name & Anniversary Date/Year________________________________________________

Home or Preferred Mailing Address:

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________


Winter Address, If Applicable:

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________


Home Phone__________________________________________

Home Fax____________________________________________

Cell Phone__________________________________________

Office Phone________________________________________

Office Fax__________________________________________

Email_______________________________________________

Website_____________________________________________

Please enclose this Application and a $100 dues check, payable to "Bill Hirsch", & remit to same @
2659 S. Parkview Drive • Hallandale Beach, FL • 33009
Phone 954.354.9375 • Cell 516.356.6678

Thank you!