EAGA Membership / Renewal Application

2024 EAGA Membership / Renewal Application
For question contact Bob Buck at rbuck@eagagolf.org or (610) 867-9295

Your Membership Dues and Contribution will help carry on the rehabilitation work of the EAGA through theMedium of golf and are tax deductible under Section 501 (c)(3) of the Internal Revenue Code of 1986.
Full Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Address*

Street Address

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CityState / Province

Postal / Zip Code
Amputation*
If you selected Other, please provide more information
Veteran
If Yes, Branch
Rank
Memberships

Amputee Membership is open to any individual who has experienced the loss of one or more extremities at a major joint due to amputation or birth defect. Those with other types of amputation are considered for membership on an individual basis.

Associate Membership is available to all non-amputees who are interested in our activities and support the work of the association.

Associate Arm Membership is available to anyone who is not an arm amputee but who plays golf with one arm.

Life Membership is available to anyone interested.
Membership Dues (Select One):

EAGA Amputee Membership - $15.00EAGA Disabled Arm Membership (Assisted & Unassisted) - $15.00EAGA Associate Membership (Non-Amputee) - $15.00EAGA Life Member - $200
EAGA Scholarship Fund (Optional). Please choose one or more of the following Scholarship Funds where you would like your Contribution to go:

MaryLou & Paul DesChamps MemorialEileen & Ray Froncillo Memorial FundHoward Taylor Memorial FundTom Reed Memorial FundBob Wilson Memorial FundBuffalo Amputee Golf Classic FundRobert O Buck, Jr Scholarship FundBill Spratt Memorial Scholarship FundNorth Hills Country Club Scholarship FundThomas Naughton Memorial Scholarship FundApplecross CC Scholarship FundBick Long Memorial Scholarship Fund
EAGA Scholarship Fund Amount (Optional):
EAGA Annual Fund Contribution (Optional):
Enter Amount
Milas Rose Memorial Fund Contribution (Optional):
Total Amount:
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2024 EAGA Membership / Renewal Application