GCSAA - Educator membership application

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Educator membership application

Educator Member - $65 -- To qualify for Educator membership, applicant must be an educator or extension officer. Educator members shall have such privileges of the Association as the Board of Directors may specify by Standing Rules, except those of voting and holding office.

Application instructions:

1. Fill out the form completely and legibly -- you can fill it out on screen and then print it.
2. After reading the code of ethics, sign and date the application where indicated.
3. Enclose check for a full year's dues ($65) or indicate credit card number.
4. Please allow up to 4-6 weeks for processing.

Important: No application will be considered without dues enclosed or valid credit card information.

Applicant information:

Preferred mailing address:

Home Business

Ms. Mr.

Name:

Home address:

City:

State:

Country:

Postal code:

Home Phone number:

Email Address:

U.S. Citizen?

Yes
No

Date of Birth:

Employer name:

Employer
address:

City:

State:

Postal code:

Country:

Employer Phone number:

Employer Fax number:

Life insurance beneficiary:

All members (excluding non-U.S. citizens, and the following member classifications: Student, Affiliate Company, Technical Assistance Network and International Superintendent members) are automatically enrolled into the dues term life insurance group policy. This benefit is at no additional cost to you - GCSAA pays for this benefit.

Insurance policy information

Name of beneficiary:

(Please print the first and last names, e.g., "Mary Smith" not "Mrs. J. Smith" or "Mrs. John Smith.")

Relationship to member:

Applicant signature:

I hereby submit my application for membership in the Golf Course Superintendents Association of America and attach my dues for one year in advance. It is estimated that 8% of my membership dues will be used for advocating positions on government issues, as well as payment of dues term life insurance for all members, excluding non-US citizens, student, affiliate company, and technical assistance network, and that a portion is therefore not tax deductible as a business expense. I have read and agree to abide by the GCSAA Code of Ethics. (Visit GCSAA.org at access a copy of the Code of Ethics.)

Signature
___________________________________________________

For GCSAA Office Use Only:

___________________________

Date:
___________________________________________________

Method of payment:

Credit card type:

VISA MasterCard American Express

Card no.:

Exp. date:

Check or money order (U.S. dollars drawn on U.S. bank) to:
GCSAA, P.O. Box 219004, Kansas City, MO 64121-9004

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The Golf Course Superintendents Association of America is dedicated to serving its members, advancing their profession, and enhancing the enjoyment, growth and vitality of the game of golf. Golf Course Superintendents Association of America 1421 Research Park Drive Lawrence, KS 66049-3859 Tel. 800-472-7878 or 785-841-2240

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