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HomeMy WebLinkAbout315474 8/30/2017 ��V ��'"• CITY OF CARMEL, INDIANA VENDOR: 359978 �, ,,' CK AMOUNT: $...*"`430.00" ONE CIVIC SQUARE GOLF COURSE SUPER.ASSOC OF AMECHE ?�; CARMEL, INDIANA 46032 1421 RESEARCH PARK DR CHECK NUMBER: 315474 LAWRENCE KS 66049-3859 CHECK DATE. 08/30/17 �M[JON.G�. DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT ORGANID SCRIP IO& MEMBER 1207 4355300 627203 430.00 (A G / 0 / 2 r- / k 8 -q © z m m n Q n 0 M k Cj X m ? x m ƒ $ 2 0 2 2 n m w O 13Lq \ I 7 « �§ # �q kW m \ m \ _ > / ? 0 E $ m 2 / § \ \ O 0 T 0 / � ^ § > / 2 T. ?. ® gz - 3 $ j \ z | = o ¥ 5 _ ) i 3 7 # z $ g § y { E 0 % i g ƒ E J 2 K -n q ] 0 \ \ CL k / 2 � 2 /E _ E - k ! 3 § \ _ 4 9 g \ / } Srpo \ 03 - } § ( / § § k I § I 3 § | 9 / « J \I mQ , k$ � \ ) \ ■ crE D \ \$ 3 \ 0 g § 2 2 7 0 I( G d k 0 ƒ 2 2 a / § g ° © _ # 2 Z a � « ) --i2 o %M= k k § i 37 7 E 2 0 > ea / /ƒ 0 \ { 79 � §/ 0) E > � E(D \ ° Tr 0 \ / CD } n 0 E \ \ 0 m ¥ y % § E CD � % ( $ § m / 0- 0 o $ ] « E CO) G / 7 \ 0 z m \ k E4.9 ? E j 0 m \ \ ° \ GCSAA 9 MEMBERSHIP RENEWAL �ascowEnnanm>oe+,r�uawnw oruawxr� 164825 1421 Research Park Drive • Lawrence,KS 66049-3859 • 785-841-2240 • 800.472-7878 • Fax 785-832-3643 Dues Invoice: 627203 2nd Notice Please Disregard if Paid OR Sign and Return to GCSAA with payment Membership Cycle: 7/1/2017- 6/30/2018 Membership Class: A Class A Renewal Cycle is: 04/06/2016-04/05/2021 Your preferred mailing address: Robert D. Higgins PO BOX 960 Westfield,IN 46074-0960 UNITED STATES ,., . > • > NEW Golf Course Information:(Provide ONLY if you have changed courses.) NEW Home Mailing Address:(Provide ONLY if you have moved.) Golf Course Name Street Street Address Address City,State,Zip City,State,Zip Country Country Phone Phone W rCurrent E-mail Information Publish E-mail address? ❑YES❑NO higgins@carmel.in.gov referred E-mail address(to be used for all GCSAA correspondence and in the Would you like to wntinue to receive ❑YES o NO CSAA Membership Directory). Go/fCourmManagementmagazine? If your position/responsibilities have changed and you have not Your current job title or position is: contacted us,please visit www.gaaa.org/membership and complete Golf Course Superintendent a reclassification form. Title I h rtify tha my inf ation is correct. Brookshire Golf Course – v 6 Facility/Company/University A Date 1 CQ.���(� 18 Member's Si nature Facility Type #Holes Renewal form willreturned Please Make A Copy For Tax Purposes: GCSAA dues are not deductible as a charitable contribution for federal income tax purposes,but may be deductible as an ordinary and necessary business expense.GCSAA estimates that 6%of your membership dues are not deductible as this portion will be used for advocating positions on government issues,as well as for the payment of dues term life insurance for all members excluding students, affiliate companies,technical assistance network and non-U.S.citizens. The Environmental Institute for Golf is exempt from taxation under Code Section 501(c)(3)of the Internal Revenue Service.Your voluntary gift is deductible as a charitable contribution for federal tax purposes to the extent provided by law. Make dtecks payable to:GCSAA U.S.Funds Only(U.S.do#ars drawn on U.S.dank) ❑Check❑credit Card Me><nt•ershEp Dues $380.00 Card Holder Name(please print) Paid Amount $0.00 ---- ---- ---- — ___ —— /20—— TOTAL DUES OWED $380.00 Card Number Expiration Date Voluntary Contribution to The Environmental Institute for Golf $50.00 Card Holder's Signature TOTAL DUES and C,ONTR SMON $430.00 =Lawrence, loin or renew the Golden Tee Club by contrlibttting an additional Questions? Online:www.gcsaa.org $50 here. rch160495.3859 r Contact member solutions at Tit TAL A#+It>UNT ENCLOSED S 800172-7878 Fax:785-832-3643 • •. .. •' REN_JN 164825 A Robert D.Higgins 627203 7/1/2017-6/30/2018 $380.00 GCSALAf;'9 Term Life Insurance Beneficiary Form GW MOM AZOM�C*AMR� 1421 Research Park Drive• Lawrence,KS 66049-3859 • 785-841-2240 • 800-472-7878 • Fax:785-832-3643 If you qualify in terms of eligibility,you are automatically enrolled into the dues term life insurance group policy. This benefit is at no additional cost to you. Eligibility } All U.S.Citizens (regardless of residence) r Non—U.S.Citizens who are Lawful Permanent Residents (LPR)of the United States as defined by the rules of the U.S.Department of State at the time of membership. r All membership classifications excluding:Student,Affiliate Company and Technical Assistance Network Benefits Age Life Insurance Benefit AD&D Benefit r Underage 65 $10,000 $10,000 r 66—69 $5,000 $5,000 r 70 and above $1,000 $1,000 We strongly encourage our members to update their beneficiary information on an annual basis to ensure their information is current. If a beneficiary is not named,state law will govern the distribution of funds.Please take a moment and update your beneficiary information in the box below.Updates to beneficiary information will automatically replace any prior beneficiary designation(s). Surviving beneficiaries will be paid equally unless otherwise indicated. Member Information Member Name (Printed) i A, First Middle Last/Surname l r 1 ' Date of Birth Member Number �— MM/DD/YYYY —� U.S.Citizen Yes No❑ Lawful Permanent Resident❑ Annual Beneficiary Update PrDate of Bir yh&Re)ati nship to Member W?J4. �( l First Middle Last/Sur m MM/DD/YYYY First Middle Last/Surname MM/DD/YYYY Contingent Date oro irth&Relationship to Member tism o First Middle LasdS r ke MM/DD/YYYY First Middle Last/Surname MM/DD/YM You must sign and date below in order to make your designation(s)official. Signature of Member Date ' `