PINE GROVE SPRINGS COUNTRY CLUB, INC.
PO BOX 56, 292 Route 9A
SPOFFORD, NH 03462
Phone: 603-363-4433 Winter: 603-399-4886 or 603-398-7149
E-mail: golf @ pgscc.com Website: www.pgscc.com

NameMEMBERSHIP FOR 2010
AddressNew / Renewal (circle one)
City, ZipPhone
E-mail 


DescriptionPriceAmount
FAMILY MEMBERSHIP - includes children age 12 and under
        (Born after 1/1/98)
        List names and birth dates of children below
$750.00$_______
SINGLE MEMBERSHIP$510.00$_______
SINGLE MEMBERSHIP WITH KIDS - includes children
        age 12 and under (Born after 1/1/98). List below
$550.00$_______
JUNIOR MEMBERSHIP - Up to and including 18 years of age
        (Born after 1/1/92)
$109.00$_______
COLLEGE AGE MEMBERSHIP Up to age 23 ( Born after 1/1/87) $250.00$_______
USGA HANDICAP ($40 after May 15) Required of all adults to
       play in any tournament. Juniors may receive a free handicap.
$35.00$_______
PRIVATE GOLF CAR FEE $310.00$_______
       Second Driver Fee $105.00$_______
SEASON GOLF CAR PASS (Single - Non-transferable) $500.00$_______
                                                (Family - Either spouse may drive) $650.00$_______
EARLY BIRD DISCOUNTS ($50.00 OFF family or single adult if
       Paid by January 15, 2010)
(-$50.00)$_______
EARLY PAY DISCOUNTS ($25.00 discount on Family or
       Single Memberships if paid by March 15, 2010)
(-$25.00)$_______
       $10.00 discount on Private Car Fee if paid by March 15) (-$10.00)$_______
NEW MEMBER DISCOUNT ($50 off Single or Family
       Membership if not a member last year.)
(-$50.00) $_______
McDonough Scholarship Donation ($10 suggested)  $_______
TOTAL $_______

Children: Name_________________________________, Birth Date__________
 Name_________________________________, Birth Date___________
 Name_________________________________, Birth Date___________

To reserve the same Private golf car space as last year, please pay by March 15.
Please return this whole form. You will receive a member card and receipt by return
mail. Make any corrections on address label above. Add your phone and e-mail address.

                                                NEW MEMBERS PLEASE SIGN BELOW

I agree to abide by the rules and regulations of the Club subject to suspension
or dismissal for violation thereof.

Signature of applicant _________________________

New Member Recommended by ____________________________________________