NORTHWESTERN PENNSYLVANIA
GOLF COURSE SUPERINTENDENTS ASSOCIATION, INC.

MEMBERSHIP APPLICATION                           DATE _____/_____/_____

PLEASE TYPE OR PRINT
Name of Applicant _________________________________________ Spouse Name____________________                                                                                                                                         
Home Street Address:                                                 City ______________ State _____ Zip Code __________             
Home Phone    (          )____________________________  Home FAX   (         )________________________                                                                        

Course or Company Name___________________________________________________________________    
Street Address _____________________________  City ___________ State _______ Zipcode ___________     
Business Phone (        )_____________________________ Business FAX  (           )_____________________     

Title or Position Held _______________________________ Date Started _____________________________
Type Of Employment     Full       or      Part Time            Explain  ____________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Describe Job Responsibilities _________________________________________________________________
_________________________________________________________________________________________
Please list E-mail address here _____________________________________
Previous Employer ______________________________ Type of Business ____________________________
Street Address ______________________________ City ____________ State ________ Zip Code_________  
Position Held ______________________________________ Length of Employment ____________________
If you are a member of the GCSAA, please insert your membership #  ________________________________
List Turf Related Associations of Which You Are or Have been a Member  & Dates _____________________        
_________________________________________________________________________________________
List Any Formal Turf Related Education &  Dates ________________________________________________
_________________________________________________________________________________________

Application must be sponsored by TWO Class A Members.  Please submit with application,  annual dues of $75.00, Plus $35.00  Plaque and Processing Fee.   Check Made Payable to:   NWPGCSA, Inc., P.O. Box 157 Forestville, PA 16035 (Note: Sponsors Should Know Applicant)

NAME_________________________DATE_________NAME_____________________ DATE _________
                                         Sponsor  Signature						                                     Sponsor Signature
APPLICANT’S SIGNATURE _______________________________________________ DATE _________

OFFICIAL USE ONLY
Membership Chairman _____________________________ President ________________________________
Date Approved  _____/_____/_____				 Classification  ________		                                                                                                                                              Date Paid _____/_____/_____	Check#_______	$________	Initiation Pack Sent________										
	MEMBAP.DOC    January 14, 2009