5410 Mockingbird Road |Greensboro, North Carolina 27406
www.atlanticcoastgolftour.com
Wendell Welch, Director
Office: (336) 674-1900 | Cell: (336) 451-0655
PROFESSIONAL
Membership Application
Please Type or Print:
Name _________________________________________________________________
**( as you wish it to appear on scoreboard, etc.)
Address _______________________________________________________________
City _______________________ St _____ Zip _______
Local Newspaper Email address: __________________________________________________________
Email Address _____________________________________________(please provide
email address to be used for information )
Cell Ph____________________ Home Ph ___________________ Work Ph____________________
Social Security Number:_______-_________-__________ ( for 1099 earnings)
Player Profile:
Career Highlights:____________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Annual Membership fee $400
Membership fee: $ _______ Fee Paid.
Visa or MasterCard Accepted
Please charge my Visa or Master Card (please circle card
type)
Account #: ______________________________________
Name as on Card: ______________________________________
Expiration Date: _______________________
Signature: __________________________________________
Please make checks payable to ACGT and mail to: Atlantic
Coast Golf Tour, 5410 Mockingbird Rd. , Greensboro, NC 27406
**There will be a $25 returned check fee and a $10 declined charge card fee**
For further information, contact Tour Director/Owner Wendell
Welch at (336) 674-1900 or Visit our web site at www.atlanticcoastgolftour.com
and email: greenseeker59@aol.com