MEMBERSHIP APPLICATION
                                                                                                                     

Please print this form and mail along with your check for $100 payable to:

DONALD ROSS SOCIETY
66 Hillsboro Drive
West Hartford, CT 06107

Name, Title  _____________________________________________________

Address       _____________________________________________________

Apt. / Suite   _____________________________________________________

City             ____________________________ State_____ Zip ____________

Daytime Phone (____)______________  Evening Phone (____)______________

Fax  (____)______________________   Email  _________________________

Date of Birth    _____ / _____/ 19_____   Maritial Status  __________________   

Handicap ______________________   Rounds per Year Played ____________  

Home Course  ___________________________________________________

Address         ____________________________________________________

City                ___________________________ State_____ Zip ____________

Course Type   (circle one)                   PRIVATE              PUBLIC              RESORT

Other Club Affiliations:    ____________________________________________________

                                  ____________________________________________________

                                  ____________________________________________________