EmailMe Form - MIAA Student Submission Form

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 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

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

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.

STUDENT INFORMATION

CONTACT & GUARDIAN INFORMATION

AGE 13 AND UNDER:

AGE 14 TO 18:

SCHOOL INFORMATION

PROGRAM SUMMARY

CONTACT &
GUARDIAN INFORMATION