Michigan Adaptive Golf Clinic- Sign up sheet

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					Michigan Adaptive Golf Clinic
Golfers (A free golf swing lesson)
Modified golf equipment will be available on site for
your lesson. You may bring your own as well.                                             C
Therapists / Golf Pro will be available for                                              L
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modification of your golf swing, making adaptations
as needed.

Registration Information (Please fill out completely)                                    N
       Name_____________________________________________                                 I
       Address___________________________________________
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       City_____________________Zip Code__________________


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       Phone ___________________________________


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Clinic Location (Directions provided upon receipt of registration or you can mapquest)

Genesee Fieldhouse Wednesday April 22, 2009
7383 Grand Parkway
Grand Blanc, MI 48439
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Choose a time for your lesson.
              1:00-2:00
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              2:00-3:00
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Your Goal for the lesson:__________________                                              T
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What do you feel you need assistance with? Can mark more than one.
    Grip (holding on to the club) __two-handed __one-handed
    Balance     __sitting __standing
    Strength
    Golf swing itself                            Questions? Contact
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    Other______________________________ Monica Haubenstricker
                                                  1-810-342-4182
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Please return this completed form to:
Michigan Adaptive Golf / McLaren Regional Medical Center                                 O
401 S. Ballenger Highway Flint, MI 48532-3685
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