Nonprofit Declined Credit Card Donation

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					                 Teaching and Club Professionals                         2009
                 100 International Golf Drive
                 Daytona Beach, FL 32124-1092
                                                                    MEMBERSHIP DUES
                 Phone: (386) 274-6200
                                                            Class A, Master Pro, Senior
NAME:                                                                   Member ID:
2009 Annual Membership Dues:                                                                              $ 425.00
Dues and Insurance: $425                      (Insurance portion of dues $30.00)

Optional LPGA-USGA Girls Golf Donation:
                        $10      $25          $50       Other_______________

In addition to my 2008 dues, I would like to support the LPGA-USGA Girls Golf Program in the amount of   $________________
Your LPGA-USGA Girls Golf donation will be acknowledged by The LPGA Foundation, a qualified nonprofit
organization under IRS code 501 ( c ) (3). All donations are tax deductible to the extent permitted by law.

Total Amount Enclosed:                                                                                   $___________

*Please note:
- 2009 membership dues must be post-marked no later than December 31, 2008
- A $150 fine will be charged to any member who fails to remit payment by December 31, 2008
- An insufficient funds penalty of $10 plus half of the amount owed may be charged on all returned
  checks and declined credit card payments

Please check method of payment:                        Check #_______________           Date of check:_______________


If paying by credit card, please complete the following:

Credit Card Number:                                                                                  Exp. Date:

                    -                     -                     -                                           /
Name as it appears on the card:____________________________________________________________________________

Authorized Signature:_____________________________________________________________________________________

Credit Card Holder’s Address (If different from member’s primary address):___________________________________

Please return this completed payment form along with the VOE to the following address:
                               Attn: Ashleigh Anderson
                           2009 LPGA T&CP Membership Dues
               100 International Golf Drive, Daytona Beach, FL 32124-1092

LPGA Checklist:

    Dues Payment Completed                          VOE Form Completed                 Rules Test Completed

                               LPGA Membership Information Updated Online

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