NCGA Credit Request Form
Golfers in question MUST be removed from the club’s active roster before any credit request will be considered.
Example - Regular to Junior? Merely edit the membership type and add a birth date; do not delete.
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* Required
Club Name
*
Your answer
Club Number
*
Your answer
Club Contact Name
*
Your answer
E-mail
*
Your answer
Phone
*
Your answer
All credits are subject to the approval of the NCGA
1) Golfer Name
*
Your answer
NCGA/GHIN Number
*
Your answer
Date Inactivated
*
MM
/
DD
/
YYYY
Amount Billed
*
Your answer
Reason
*
No longer a member
Wrong billing rate ( Junior w/ D.O.B. vs Regular)
Deceased
Other:
2) Golfer Name
Your answer
NCGA/GHIN Number
Your answer
Date Inactivated
MM
/
DD
/
YYYY
Amount Billed
Your answer
Reason
No longer a member
Wrong billing rate ( Junior w/ D.O.B. vs Regular)
Deceased
Other:
Clear selection
3) Golfer Name
Your answer
NCGA/GHIN Number
Your answer
Date Inactivated
MM
/
DD
/
YYYY
Amount Billed
Your answer
Reason
No longer a member
Wrong billing rate ( Junior w/ D.O.B. vs Regular)
Deceased
Other:
Clear selection
4) Golfer Name
Your answer
NCGA/GHIN Number
Your answer
Date Inactivated
MM
/
DD
/
YYYY
Amount Billed
Your answer
Reason
No longer a member
Wrong billing rate ( Junior w/ D.O.B. vs Regular)
Deceased
Other:
Clear selection
5) Golfer Name
Your answer
NCGA/GHIN Number
Your answer
Date Inactivated
MM
/
DD
/
YYYY
Amount Billed
Your answer
Reason
No longer a member
Wrong billing rate ( Junior w/ D.O.B. vs Regular)
Deceased
Other:
Clear selection
6) Golfer Name
Your answer
NCGA/GHIN Number
Your answer
Date Inactivated
MM
/
DD
/
YYYY
Amount Billed
Your answer
Reason
No longer a member
Wrong billing rate ( Junior w/ D.O.B. vs Regular)
Deceased
Other:
Clear selection
7) Golfer Name
Your answer
NCGA/GHIN Number
Your answer
Date Inactivated
MM
/
DD
/
YYYY
Amount Billed
Your answer
Reason
No longer a member
Wrong billing rate ( Junior w/ D.O.B. vs Regular)
Deceased
Other:
Clear selection
8) Golfer Name
Your answer
NCGA/GHIN Number
Your answer
Date Inactivated
MM
/
DD
/
YYYY
Amount Billed
Your answer
Reason
No longer a member
Wrong billing rate ( Junior w/ D.O.B. vs Regular)
Deceased
Other:
Clear selection
9) Golfer Name
Your answer
NCGA/GHIN Number
Your answer
Date Inactivated
MM
/
DD
/
YYYY
Amount Billed
Your answer
Reason
No longer a member
Wrong billing rate ( Junior w/ D.O.B. vs Regular)
Deceased
Other:
Clear selection
10) Golfer Name
Your answer
NCGA/GHIN Number
Your answer
Date Inactivated
MM
/
DD
/
YYYY
Amount Billed
Your answer
Reason
No longer a member
Wrong billing rate ( Junior w/ D.O.B. vs Regular)
Deceased
Other:
Clear selection
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