Eastside Senior Golf Association
established in 2005  
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2012 APPLICATION FORM
2012 Membership ESGA Membership Application
(Must be age 50 or older to be elgible and belong to a participating club)

Please enter this information and submit it.  You will be contacted that it has been received.  Please mail your check for $80.00 to David Fratzke, 2104 Linda Lane, La Grande, OR   97850.  (541 963-2080)  Thank you.
First Name:
Last Name:
Address Street:
City:
State:  
Zip Code:  (5 digits)
GHIN Number  (7 digits - No "dash")
Daytime Phone:
Date of Birth  (month/day/year)
Email:
Comments:

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