Golf Associate Barcodes

Name as it appears on your Photo ID*

First NameLast Name

Email*

example@example.com

Cell Phone Number*

Please enter a daytime number in the event we need to follow-up regarding your barcodeFormat: (000) 000-0000.

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

I am a new Golf Associate MemberI am a returning Golf Associate Member

The fee for a Golf Associate barcode is $10. Once we receive this form, an associate from the Member Services Team will call you within two business days to make a payment over the phone and book an appointment for placement. The barcode will be valid for 1-year from the date of purchase.

License Plate*

State Issued*

Make of Vehicle*

Model*

Color*

Year*

Upload and picture of the registration for your vehicle*

We appreciate your assistance in auditing our system by providing the information below. Once received, we will check it against the existing record. The renewal for your Golf Associate barcode will be $10. Once we receive this form, an associate from the Member Services Team will call you, within two business days, to make the payment over the phone. We will then extend your barcode access for another year.

Barcode #*

(5 numbers can be found on your existing barcode)

License Plate*

State Issued*

Year*

Make of Vehicle*

Color*

Model*

The person receiving an LMOA access barcode shall indemnify, protect, and hold harmless the LMOA and its Board of Directors from and against all liabilities, obligations, claims, accidents, casualties, occurrences, damages, causes of action, costs, and expenses, including without limitation, reasonable attorney's fees, and expenses, imposed upon or incurred by or asserted against the Association or its Board of Directors because of the issuance of this access device. The Association and its Board of Directors reserve the right to designate counsel. The use of this access device is governed by the current conditions set forth by LMOA, which may be amended without notice from time-to-time. The holder of the LMOA access barcode agrees to surrender the access device to the LMOA upon demand.

Signature*

Desktop: sign with your mouse | Tablet or Phone: sign using your finger or stylus