Birck Boilermaker Golf Course Membership Form

Birck Boilermaker Golf Complex Membership Form

Please fill out the following details to apply for your 2026 Membership.
Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Membership Status
Address

Street Address

Street Address Line 2

CityState

Zip Code
Desired Membership Type
Enter your Purdue Email Address
Used to verify status for membership
Birthdate

MonthDayYear
Would you like to add a golf cart membership?
Please select a golf cart membership
A spouse and dependents under 25 years old in same household can be added for a one-time fee. Members now have the option to pay a fee for each individual added to the membership. Alternatively, there is a one-time fee available that will cover the entire household.
Would you like to add family members to your membership?
Select which group(s) you would like to add to your membership?
Select the number of children between the age of 15-25 to add to your membership
Select the number of children age 14 & under to add to your membership
Please provide the name and email for all dependents being added to your membership. To enter information for multiple people, press "SAVE" for a new row to appear until you have provided the information for your dependents.
How would you like to pay for your membership?
Please select payment plan frequency
Payment Plan Start Date

MonthDayYear
Date
I would like to receive more information on:
Signature
Membership Cost
Payment Plan Down Payment
Total Amount Due
Should be Empty:

Birck Boilermaker Golf Complex Membership Form