Student Semester Memberships
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Entered by: ______________ THE Checked by: _____________ GOLF COURSE Student Semester Memberships Semester � Student Fall � SpringMemberships � Summer Student Semester Memberships � Fall � Spring � Summer ✓ Fall Spring Summer Date Range: ____________________________________________________________________ Date Range: ____________________________________________________________________ Student ID #: ___________________________________________________________________ Student StudentID ID#:#: ___________________________________________________________________ ___________________________________________________________________ Name: _________________________________________________________________________ (please print as it appears on your student id) Name: Name:_________________________________________________________________________ _________________________________________________________________________ (please (pleaseprint printas asititappears appearson onyour yourstudent studentid) id) Local Address: __________________________________________________________________ Local LocalAddress: Address:__________________________________________________________________ __________________________________________________________________ _______________________________________________________________________________ City State Zip _______________________________________________________________________________ _______________________________________________________________________________ City State Zip City State Zip Permanent Address: _____________________________________________________________ Permanent PermanentAddress: Address: _____________________________________________________________ _____________________________________________________________ _______________________________________________________________________________ City State Zip _______________________________________________________________________________ _______________________________________________________________________________ City State Zip City State Zip Home Phone: ______________________________Cell Phone:___________________________ Home HomePhone: Phone: ______________________________Cell ______________________________CellPhone:___________________________ Phone:___________________________ Email:____________________________________________________ Email:____________________________________________________ Email:____________________________________________________ Membership Type (please check one of the following) Membership MembershipType Type (please (pleasecheck checkone oneofofthe thefollowing) following) ______Student-Basic: $295/semester ______Student-Expanded: $565/semester ______Student-Basic: ______Student ______Student-Basic: $295/semester ______Student-Expanded: $565/semester ______ Student Membership: $325/semester _______Cart Program:$295/semester $299/semester ______Student-Basic: $295/semester ______Student-Expanded: $565/semester Student Semester Membership guidelines: � Student-Basic membership covers green fees only. Student Semester guidelines: Student SemesterMembership Membership guidelines: Student-Expanded membership covers green fees, cart fees, and selected member benefits. membership green fees �� Student-Basic Student membership coverscovers green fees only. Student-Basic membership covers green feesonly. only. Membership dues must be paid in full before membership begins. membership covers green fees, and �� Student-Expanded Membership dues must be paid in full before membership Student-Expanded membership covers green fees,cart cartfees, fees,begins. andselected selectedmember memberbenefits. benefits. � Membership fee, cart fees, merchandise, food, etc may be charged to your Bursar account. account. Membership dues must be paid in full before membership begins. � Membership fees, food,membership etc may be charged Membership fee, duescart must be merchandise, paid in full before begins. to your Bursar � Bursar billing will be processed the last day of each month. You will receive an notice. email Membership fee, cart fees, merchandise, food, etc may be charged to your Bursar account. � Bursar billingfee, willcart be processed the last day of etc each month. You willtoreceive an email Membership fees, merchandise, food, may be charged your Bursar account. notice. � Bursar Bursar billing billing will will be be processed processed the the last last day day ofof each each month. month. You You will will receive receive an an email email notice. notice. Method of Payment Bursar $ ________ Credit Card $ ________ Method MethodofofPayment Payment Bursar Credit Bursar $$________ ________ CreditCard Card$$________ ________ Check $ ________ Cash $ ________ Check Cash Check $$ ________ ________ Cash$$________ ________ Office Use Only Office OfficeUse UseOnly Only Verified Bursar ___ Entry Completed ___ Verified Bursar Verified Bursar ___ ___ Entry EntryCompleted Completed ___ ___ It is understood that if I fail to comply with the Rules and Regulations set forth by the Ole Miss Golf I will be subject to to suspension or cancellation ofRegulations membership by the Ole Golf Course. ItCourse, that ififI Ifail the by the Miss Golf Itisisunderstood understood that fail tocomply complywith with theRules Rulesand and Regulationsset setforth forth byMiss theOle Ole Miss Golf Course, I will be subject to suspension or cancellation of membership by the Ole Miss Golf Course. Course, I will be subject to suspension or cancellation of membership by the Ole Miss Golf Course. Signature: _________________________________________ Date: _________________ Signature: Signature:_________________________________________ _________________________________________ Date: Date:_________________ _________________ 28187-4/12 18655-1/10
