EL SEGUNDO GOLF CLUB REQUEST FOR APPLICATION

For Membership in the El Segundo Golf Club, please print, fill out and email completed Form to

Larry Owen at llowen@aol.com, 310-322-1710 or mail, 216 Richmond Street, El Segundo, CA. 90245.

Name: (Last) _____________________(First)________________ Initial) ___

Home Address: _________________________________________________

City: _________________ Zip Code: ________ Telephone: _______________

Bus Tel: ______________ Other Club Affiliation: ________________________

E-Mail Address: __________________________________

Signed: __________________________ Date: _________________