Date__________

Member Name____________________________________DOB_______________

Spouse Name_____________________________________DOB_______________

Address____________________________________________________________

City_____________________State______________________Zip Code_________

Home Phone____________Work Phone____________Cell Phone_____________

Email Address_______________________________________________________

2014 Membership Dues

Season Membership Dues Seasonal Cart

• 35 and under _____650 _____550

• Single _____800 _____550

• Senior (63+) _____650 _____550

• Couple _____1375 _____550 (per person)

• Couple – Senior _____1250 _____550 (per person)

• College Student _____350 _____NA

• Junior _____125 _____NA

Monthly Membership

• Single _____150 _____NA

• Senior _____130 _____NA

• Couple _____275 _____NA

• GHIN Handicap _____35

• Driving Range _____185

• Total Due_______________________

*College Membership is full time student age 22 and under

*Junior Membership is age 19 and under

*Dues paid by February 28 receive 8% clubhouse / pro shop credit of amount paid

*Dues paid by March 23 receive 4% clubhouse / pro shop credit of amount paid

P.O. Box 1485, Lanesboro, Ma 01237

Phone: 413-445-5584

www.skyline-cc.com

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