Black River Golf Club
2009 Membership Application

I/we herewith subscribe to a membership in (please check one):

_________  Black River Golf Club

_________  Combined BRGC / Tee Hi

_________  Handicap fee/trail fee (no tax)

Membership Type        Membership Rate        Tax 5.5%        Total

______________            $____________        $_______        $_________
(Family, Single, etc)

Please make check payable to:    Black River Golf Club, Inc.
                                               P.O. Box  396
                                               Medford, WI 54451

Please send prior to April 15th 2009

Name _____________________________________________________________

Children's names  ____________________________________________________

Address  ___________________________________________________________

             ___________________________________________________________

Signed __________________________________     Date ____________________

Notes:
* If family, please list names of all who will be playing golf.  (husband, wife, and children)
* We will handle details regarding apportionment of combined membership fee with Tee-Hi.
   Only one check needs to be sent.    Thank you.