APPLICATION FOR MEMBERSHIP

                                                                                                    _______________

                                                                                                               Date 

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.

 PERSONAL DATA

_________________________________              ____________________________         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

_________________________________            ________________________                            Nominated by:                                                            Handicap

                Committee’s Action:                          Date:_________________