Member Registration

For questions or registration assistance contact
Nancy Boulter at vpmembership@pbcwga.com

Member Type*

New Member
Returning Member

Email Address*

Password*

Forgotten Password

Name*

Firstname Lastname

Home Address

Home Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number (H)*

Mobile Phone Number

Preferred Phone Number

Home
Mobile

Mailing Address

Copy Address

Click here if Mailing address is the same as above

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Other Information

Your Golf club*

Handicap Index

GHIN/Golfnet Type

GHIN/Golfnet Number*

Are you the club delegate

No
Yes

Payment Information

Fee

Payment Method*

Credit Card
Bank Check

Credit Card Information*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Bank and check #*

Bank Name # 000000

Check Payable to PBCWGA. Mail Check and completed application to: Attn: Chris Reilly, 1385 Bear Island Dr. ,West Palm Beach, FL 33409

I agree to indemnify and hold harmless Palm Beach County Women’s Golf Association and it’s Executive Board Members from and against all claims, damages, losses and expenses, including, but not limited to, attorney fees arising out of, or resulting from, actions that I may be involved in the either cause harm to me or result in damage to the club’s facilities or equipment. By clicking on Submit, you agree to the terms/statement noted above.

Name

This field is for validation purposes and should be left unchanged.