Full Name:

Address:

City/State/Zip:

Country:

Phone:

Fax:

Web Site:

Email Address:

How many years have you been a golf sales representative? _____

I am (check one): ___ Independent Rep   ___ Company Rep   ___ Associate

Please list territory covered (List all states i.e. AZ, NV, NM) below:

__________________________________________________________

Please list lines carried below:

_________________________         ____________________________

_________________________         ____________________________

_________________________         ____________________________

Do you receive (check one): ___ Commissions Only ___ Salary Only ___ Both

Thank you for supporting the NGSA with your Membership and completing the information requested. Membership is for 1 year (12 Months) from the date of receipt of membership. The NGSA Membership fee is $50.00

Make your check or money order payable to NGSA. Send membership information and payment to the following address: NGSA, P.O. Box 6134, Scottsdale, AZ 85261-6134