Name: First Last

Address:

City: State: Zip:

E-mail Address:

Telephone Number: (xxx-xxx-xxxx)

Day Night Cell

Date of Birth: (mm/dd/yy)

GHIN #:

Club Name:

Membership Fee Enclosed: $50.00

Print and mail with copy of Alabama drivers license and check (made payable to WAGA) for membership dues ($50.00) to:

WAGA
1025 Montgomery Highway, Suite 210
Birmingham, AL 35216