Membership Online Application Website Proudly Sponsored By: MEMBERSHIP APPLICATION FORM PEAKS & PRAIRIES GCSA P.O. Box 5003, Missoula, MT 59806 Tele: 406-273-0791 www.ppgcsa.org ppgcsa@ppgcsa.org Section IName(Required) First Last Course/Company NameOffice Mailing Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingOntarioQuebecNova ScotiaNew BrunswickManitobaBritish ColumbiaPrince Edward IslandSaskatchewanAlbertaNewfoundland and Labrador State / Canadian Province Zip Code Office/Shop PhoneOffice/Shop Toll FreeCell/MobileDate Started Present Position MM slash DD slash YYYY Title of PositionEmail(Required) Enter Email Confirm Email Type of CourseNumber of HolesI would prefer to recieve all mailings at my:(Required) Home Address Office Address Are you a licensed pesticide applicator?(Required) Yes No Are you a member of GCSAA?(Required) Yes No GCSAA Class & Membership NumberAre you a GCSAA Certified Superintendent?(Required) Yes No Next Recertification Date MM slash DD slash YYYY Past Positions Held (Do NOT include Present Position)From Mo. & Yr.To Mo. & Yr.Place of EmploymentCity & StateJob Title Add RemoveHome Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingOntarioQuebecNova ScotiaNew BrunswickManitobaBritish ColumbiaPrince Edward IslandSaskatchewanAlbertaNewfoundland and Labrador State / Canadian Province Zip Code Home PhoneSpouse's NameHow would you like to recieve the membership directory?Yes, Please send me a paper copyNo, I only need a digital accessClass Fees A(Superintendent 3 years & over) $155 B (Superintendent less than 3 years) $155 C (Assistant Superintendent) $155 D (Allied/Commercial/Supplier) $170 E (Student - requires signature) $30 EM (Equipment Manager/Technician) $110 F (Professor / Former Class A, B, or C member/ Interested in Turf Mgt / Course employees other than supers & assistants) $100 FM (Facility Membership as defined in bylaws) $155 Retired (as defined in bylaws) $50 JS (Non-member Job Service ONLY) See restrictions below, Section V. $45 Allied CompaniesEach Allied Member Firm is allowed two additional listings, besides the Primary Member, on the Peaks & Prairies mailing list.These members may be at a different location. SHOULD THE ADDITIONAL LISTINGS ALSO BE INCLUDED IN THE MEMBERSHIP DIRECTORY UNDER YOUR BUSINESS? Yes No How many people to add?NoneOne PersonTwo PeopleAdditional PersonName First Last Company NameAddress Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingOntarioQuebecNova ScotiaNew BrunswickManitobaBritish ColumbiaPrince Edward IslandSaskatchewanAlbertaNewfoundland and Labrador State / Canadian Province Zip Code Cell PhoneToll FreeEmail Enter Email Confirm Email Second Additional PersonName First Last Company NameAddress Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingOntarioQuebecNova ScotiaNew BrunswickManitobaBritish ColumbiaPrince Edward IslandSaskatchewanAlbertaNewfoundland and Labrador State / Canadian Province Zip Code Cell PhoneToll FreeEmail Enter Email Confirm Email Types of products/services offered, companies represented:Required for StudentsClass (E) STUDENT To qualify for student membership, an applicant must be enrolled full-time in a college or university involved in the field of turf management. Applicants must obtain the signature of their major professor or a superintendent or assistant superintendent who is a member of this association as a sponsor of their membership.College/ University(Required)Name of Major Professor/ or Superintendent Sponsor(Required)Date(Required) MM slash DD slash YYYY Phone(Required)Section IIEFFECTIVE JULY 1, 1997 each applicant for Class A or B membership must present either an application form, or evidence of membership, with the Golf Course Superintendents Association of America (GCSAA).I hereby apply for the designated Peaks & Prairies GCSA classification listed above and submit my payment, or request an invoice (see below). Payments are not prorated. Our year is April 1 – March 31.Job Service ApplicantsThe Peaks & Prairies GCSA job service is not a membership and it is available for the sole purpose of an individual seeking employment in the turf industry. The information contained within this site is not available for distribution and it cannot be used for communication by any other means than intended. If you do not meet this criteria as an individual applying for the job service, your application fee will be returned. We reserve the right at any time and for any reason to deny you access to the job service and to terminate this service if you are not using the job service as intended.Signature of Applicant(Required)Date(Required) MM slash DD slash YYYY Class AA, A ,B, C members: Please complete for your Green Chairman to receive a complimentary copy of The Perfect Lie newsletterToCourseMailing Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingOntarioQuebecNova ScotiaNew BrunswickManitobaBritish ColumbiaPrince Edward IslandSaskatchewanAlbertaNewfoundland and Labrador State / Canadian Province Zip Code Payment can be made through Paypal, credit card or check. If you wish to pay with a check, please select INVOICE ME from the dropdow below. When selecting PayPal/Credit Card, you can either login with your PayPal account, or select to checkout without a PayPal account and select the credit card option.PayPal/Credit Card Fee Price: $0.00 Total Payment OptionPayPal/Credit CardInvoice MePayPal is our CC processor.Payment MethodPayPal Checkout MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name Δ
