NIKKEI SENIOR GOLFERS MEMBERSHIP RENEWAL FORM


	

Name:_____________________________________________ Birthday (Opt.)___________                               


Name:_____________________________________________ Birthday (Opt.)___________                              


Address:__________________________________________  


City:   _________________________________  State:______  Zip:___________
        
				
Telephone:____________________   Cell Phone: (M):_________________


                                             (F):_________________
                                                           


E-Mail: (M)______________________________  E-Mail: (F)______________________________


GHIN#: (M)_____________________ (F)_____________________


Membership dues: $50.00 per person - $100.00 per couple


Please make check out to Nikkei Senior Golfers and send to Namomi Endo before November 30.
Late fees will be accessed for those who are unable to meet the deadline.

  Naomi Endo
  
  1040 S. Grandridge Ave.
  
  Monterey Park, CA 91754





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