I,________________________________________herewith make application for  membership in the PRO DUFFERS GOLF CLUB, INC. USA and send herewith the sum of ___$175.00______dollars for the first years dues.

_________________________________              ____________________________               Business or Employer                                 Position or Title

_________________________________              ___________________________                Business Address                                      City, State, Zip Code

_________________________________              _________________________                Business Telephone                                    E-mail address

_________________________________            _____________________________               Home Address                                  City, State, Zip Code 

_________________________________            _____________________________             Wife’s First Name                                Number of Children

                Committee’s Action:                          Date:_________________