Date received:_____/_____/______ (office use only)               Membership number:____________ (office use only) 

Membership type:  Single____ Family:____ Corporate:____ Multiple:____ Junior:____Social:___ Summer:___ 

Personal Information 

Applicant Name(s):______________________________________________________________________ 

Current home address:_______________________________________________________________________ 

City:___________________________________ State:_________ Zip:___________ 

Home Phone:(       )_____________________ Secondary Phone:__________________________ 

E-Mail address:_________________________________________________________________ 

Social Security #______________________ Driver’s License #___________________________ 

Date of Birth:_____________________ 

How did you hear about us?___________________________________________________________________________ 

Member Refrences:_____________________________________________________________________ 

Personal References:_____________________________________________________________ 
 

Family Information 

Name of spouse:_____________________ 

Name(s) & Age(s) of childred under the age of 23:  

_____________________________________________________________________________ 

Additional Service Available 

Monthly cart rental:______ Bag storage:_____  Men Locker rental:_____ Women Locker Rental:_____ 

Join MGA ($120 a year):________     Join WGA($75 a year):__________