Membership Signup Website Proudly Sponsored By: MEMBERSHIP APPLICATION FORM P.O. Box 5003, Missoula, MT 59806 Tele: (406) 273-7779 www.iegcsa.org iegcsa@iegcsa.org Section IName* First Last Course/Company Name*Office Mailing Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingOntarioQuebecNova ScotiaNew BrunswickManitobaBritish ColumbiaPrince Edward IslandSaskatchewanAlbertaNewfoundland and Labrador State / Canadian Province Zip Code Office/ Shop Phone*Office/ Shop FaxOffice/ Shop Toll FreeCell/MobileDate Started Present Position MM slash DD slash YYYY Title of PositionEmail Address Type of CourseNumber of HolesI would prefer to recieve all mailings at my:* Home Address Office Address Are you a licensed pesticide applicator? Yes No Are you a member of GCSAA? Yes No GCSAA Class & Membership NumberAre you a GCSAA Certified Superintendent? Yes No Next Recertification Date MM slash DD slash YYYY Past Positions Held (Do NOT include Present Position)From Mo. & Yr.To Mo. & Yr.Place of EmploymentCity & StateJob Title Home Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingOntarioQuebecNova ScotiaNew BrunswickManitobaBritish ColumbiaPrince Edward IslandSaskatchewanAlbertaNewfoundland and Labrador State / Canadian Province Zip Code Home PhoneSpouse's NameThis field is hidden when viewing the formHow would you like to recieve meeting registration?Yes, Please send me a paper copyNo, I only need a digital copyClassification Fees A(Superintendent 3 years & over + designated requirements) $175.00 B (Superintendent less than 3 years) $175.00 C (Assistant Superintendent) $135.00 EM (Equipment Manager) $135.00 Affiliate (Allied/Commercial/Supplier) $175.00 Associate (Interested in golf course management or crew member) $135.00 FM (Facility Membership as defined in bylaws) $175.00 Student $35.00 Student rate (A fulltime student as defined in the bylaws and not a year round employee) Regional Student Free Student rate (A fulltime student as defined in the bylaws and not a year round employee) Job Service ONLY $45.00 ATTENTION: AFFILIATE MEMBERSSection IITypes of products/services offered, companies represented:Section IIIClass (E) STUDENT To qualify for student membership, an applicant must be enrolled full-time in a college or university involved in the field of turf management. Applicants must obtain the signature of their major professor or a superintendent or assistant superintendent who is a member of this association as a sponsor of their membership.College/ University*Signature of Major Professor/ or Supt. Member Sponsor*Date* MM slash DD slash YYYY Phone*ALL APPLICANTS COMPLETE: I hereby make application for membership* in the INLAND EMPIRE Golf Course Superintendents Association and attach my dues payment. Our year is from January 1 – December 31 and dues are not prorated.Signature of Applicatant*Date* MM slash DD slash YYYY EFFECTIVE JULY 1, 1997 each applicant for Class A or SM membership must present either an application form, or evidence of membership, with the Golf Course Superintendents Association of America (GCSAA).Pay online with your debit/credit card, or Paypal account. You do not have to have a Paypal account. If you would like to pay by check, please select invoice me.Payment Options*Pay via Credit/Debit CardInvoice MePayment by credit/debit card includes a 3% service fee. Price: $0.00 This field is hidden when viewing the formName on Pay Pal or Credit Card Account First Last *HIDDEN*Email* Total $0.00 Payment MethodPayPal Checkout MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name Δ
