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Reinstatement application

Application instructions:

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

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

Select the appropriate member class:
Annual dues rates effective May 1, 2008.
Affiliate (AF): $320  
Assistant Superintendent Member (C): $160 Student (S): $65
Associate (AS): $160 Student Web-Only (SW): $30
Educator: $65 Superintendent Member (SM): $320
International Superintendent Member (ISM): $160      
Applicant information:
Preferred mailing address: Home Golf Course
Ms. Mr.
Name:
Home address:
City:
State:
Country:
U.S. Citizen? Yes No
Postal code:
Phone number:
Fax number:
E-mail:
Date of birth:
Education information (please indicate highest level of education earned):

Bachelor's Degree Turf/or Plant Sciences
Other Bachelor's Degree, plus Associate's Degree in Turf/or Plant Science or 2-year Turf Certificate from 4-Year institution (e.g., Michigan State, Penn State)
Other Bachelor's Degree
Associate's Turf/or Plant Science Degree or 2-year Turf Certificate from a 4-year institution (e.g. Michigan State, Penn State)
Turf Certificate/Short Courses (400 hr. minimum)
Other Associate's Degree
No Degree or recognized Certificate
 
Employment information:
Golf course:
Address:
City:
State:
Country:
Postal code:
Phone number:
Fax number:
E-mail: (*required)
Title of position: Golf Course Superintendent
Superintendent/Owner
Golf Course Maintenance Director
Asst. Golf Course Superintendent
GC Maintenance Staff/Employee
Other Golf Course Management:
Date started position: Month Day Year
Type of golf course: Daily fee/public Semiprivate Private Resort Military/Municipal
Number of holes: 9 18 27 36+
Past positions held (prior to current employment):
Place of Employment #1:
Title of position: Golf Course Superintendent
Superintendent/Owner
Golf Course Maintenance Director
Asst. Golf Course Superintendent
GC Maintenance Staff/Employee
Other Golf Course Management:
From (month/yr): To (month/yr):
City:
State:
Place of Employment #2:
Title of position: Golf Course Superintendent
Superintendent/Owner
Golf Course Maintenance Director
Asst. Golf Course Superintendent
GC Maintenance Staff/Employee
Other Golf Course Management:
From (month/yr): To (month/yr):
City:
State:
Place of Employment #3:
Title of position: Golf Course Superintendent
Superintendent/Owner
Golf Course Maintenance Director
Asst. Golf Course Superintendent
GC Maintenance Staff/Employee
Other Golf Course Management:
From (month/yr): To (month/yr):
City:
State:
Dual membership requirement (Golf Course Superintendents only):

Notice: All applicants for Superintendent member membership must also be a member of a GCSAA Affiliated Chapter. If you are choosing to maintain an individual vote, please remember that you must be present at the annual election to cast your vote or you must assign your vote to a proxy.
Are you a member of a GCSAA-affiliated chapter? Yes No
Name of chapter:

Vote will automatically go to chapter unless marked individual.

 Individual
Life insurance beneficiary:
All members (excluding non-U.S. citizens, and the following member classifications: Student, Affiliate Company, Technical Assistance Network, and International Superintendent Member), are automatically enrolled into the dues term life insurance group policy, GL#1041. This benefit is at no additional cost to you - GCSAA pays for this benefit.
Insurance enrollment 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:

I hereby apply for insurance under Group Policy issued to the Golf Course Superintendents Association of America by UNUM Life Insurance Company of America, subject to all the terms, conditions and provisions of said policy.

To review and/or change your beneficiary information at any time, call 800-472-7878.
Applicant signature:
I hereby make application for membership in the Golf Course Superintendents Association of America and have attached herewith my dues for one year in advance. It is estimated that 8% of these membership dues will be used for advocating positions on government issues, or is for payment of dues term life insurance for all members excluding affiliate companies, technical assistance network, students and non-U.S. citizens, and that portion is therefore not tax deductible as a business expense.
Signature:
___________________________________________________

For GCSAA Office Use Only:

___________________________
Membership Chairman Signature
Date:
___________________________________________________
Method of payment:
Card type: VISA MasterCard American Express
Cardholder name:
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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