NCGA SIR Club Officials Roster 2012

In order to accurately maintain our records, please complete the club officer positions that need to be updated. To efficiently update our records include your NCGA GHIN number. The form may be emailed to Maryjane Hatch at mhatch@ncga.org or faxed to 831-625-7271.

Club Name and Club Number *
Month of Annual Board Elections and Club Inception Date
Club Fees *
Club Web Site
Where does the club play most often
Handicap Chair - Name * First Last
Phone - (###) - ### ####
Handicap Chair - Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Handicap Chair GHIN Number *
Email
Billing Contact - Name
(the following individual will receive all NCGA billing invoices) * First Last
The following individual will receive all NCGA billing invoices.
Phone - (###) - ### ####
Billing Contact - Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Billing Contact - GHIN Number *
Email
Form filled out by (Name & Title)
Phone - (###) - ### ####