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.
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?*

YesNo
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?*

YesNo
Select which group(s) you would like to add to your membership?*

Entire HouseholdSpouseChildren between the age of 15-22Children age 14 and under
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:

Purdue Pro Shop offeringsClub fitting servicesGolf lessonsJunior golf programmingMember eventsAll of the Above
Signature*

Clear
Membership Cost
Payment Plan Down Payment
Total Amount Due
Should be Empty:

Birck Boilermaker Golf Complex Membership Form