Form Instructions: Fill out this form completely.

Your First Name: Last Name:

Facility Name:

Address:

City: , State: , Zip:

Telephone: , Fax:

Email:

Type of Facility: Choose One... Private Daily Fee Resort Public Municipal Range Other

Supervisor's Name: , Title:

Brief Description of Duties:

Date of Internship: Start:  End:

Anticipated Hours of Work Per Week:

Wage Rate:

Do Interns Earn Gratuities? Choose One... Yes No , If so, how much per week:

Special Skills Required:
   Club Repair | Tournament | Jr./Beginner Lessons | Other:

Privileges:
   Playing | Range | Lessons |  Merchandise |  Meals

Is Housing Provided? Choose One... Yes No . If No, is Housing Subsidized? Choose One... Yes No

Distance from Facility:

Approximate Cost (per month) of Housing (if known):

Thank you for your interest in our program, and we look forward to processing your information as soon as possible.