Electric Association of Chicago - Serving the Chicagoland Electrical Community Since 1926

EGC Dues

	Online dues payment for the Electric Golf Club

Name
Company
Company Street Address
Company City, State, ZIP
Phone
Fax
Email Address
Referred to EGC By:
Method of Payment
Credit Card Number
Card Security Code	(3 digits on back of card - example)
CC Exp. Date
Cardholder name
	Credit card billing address is the same as company address above If credit card billing address is different from company address, please specify below:
CC Billing Street Address
CC Billing City, State, ZIP
Signature (if printed)	_____________________________________________
	By submitting this electronic form, I authorize the Electric Association to charge the amount of $60.00 (plus 5% processing fee) to the above credit card for my yearly dues in the Electric Golf Club (all prices are in US dollars).

If you prefer not to register online, please sign and print this page, and fax it to the Electric Association at: 708-547-9920 (fax).