EmailMeForm
MIAA Student Submission Form
Thank you for applying for a Mass Golf Membership and GHIN Handicap Index. Please complete the following form and a member of our staff will follow up with you directly.
STUDENT INFORMATION
Name
*
Gender
Male
Female
Date of Birth
*
MM
/
DD
/
YYYY
Mailing Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Have you ever had a USGA GHIN Handicap Index with a golf club either in or out of state?
*
No
Yes
If you answered yes, what was your GHIN #.
CONTACT &
GUARDIAN INFORMATION
Age 13 and under: A guardian is required and must complete this form and provide contact information. A guardian must be at least 19 years of age. Do not provide your contact information if you are under the age of 13.
Age 13 to 18: You may designate a guardian, but a guardian is not required. A guardian must be at least 19 years of age.
Please note: THIS APPLICATION WILL NOT BE PROCESSED WITHOUT PROVIDING PROPER CONTACT AND GUARDAIN INFORMATION
AGE 13 AND UNDER:
I am under the age of 13 and my guardian is completing this form
Yes
Guardian Name:
Guardian Email
Guardian Cell Phone
###
-
###
-
####
Guardian GHIN # (if they have one)
Guardian Relationship
Please select
Mother
Father
Legal Guardian
Coach
Other
AGE 14 TO 18:
I am age 14 to 18 and:
I am providing my contact information
My guardian is providing their contact information
I am providing contact info for both me and my guardian
Student Email
Student Cell Phone
###
-
###
-
####
Guardian Cell Phone
###
-
###
-
####
Guardian Name:
Guardian Email
Guardian GHIN # (if they have one)
Guardian Relationship
Please select
Mother
Father
Legal Guardian
Coach
Other
SCHOOL INFORMATION
School Name
*
School Hometown
*
Primary Sport
*
Primary Sport Coach Name
*
Primary Coach Email
*
Primary Coach Phone
###
-
###
-
####
Athletic Director Name
Athletic Director Email
PROGRAM SUMMARY
This program is made possible through the coordination and cooperation of the MIAA and Massachusetts Golf Association. The program will provide Mass Golf/USGA GHIN Membership AT NO CHARGE to current MIAA Students through age 18.