CALLIPPE SENIOR GOLF CLUB

Renewal Membership Dues $80

Note: The $80 fees include club membership and NCGA dues (required for each membership in each club).

*Required information (Only fill in the other blanks if something has changed)
Membership is from January 1, 2012 to December 31, 2012

Renewal after October 31 $90 ($10 late fee )

          *Name (First & Last)   ____________________________________

          Address                ________________________________________                             

          City                      ________________________________________     

          State                    ________________________________________     

          Zip Code               ________________________________________

          Email Address      ________________________________________     

          Phone - Home      ________________________________________     

          Phone - Work       ________________________________________

          Phone - Cell         ________________________________________

I apply for membership renewal to the Callippe Senior Golf Club, a nonprofit organization, and agree to be bound by all by-laws, rules and regulations of said club; and all agreements that have been entered into by said club as of the date of this application; and all the agreements that the board of directors and officers of club enter into subsequent to the date of this application.

Signature:________________________________              Date:______________

Mail Application and Check to:
Callippe Senior Golf Club
C/O Joe Kettwig
640 Carlsbad CT.
Livermore, CA 94551                     
jkettwig@comcast.net                                                                                      
Club Website:   www.callippeseniorgolfclub.com

                                                                                                     Revised October 8,  2011