2011 charity golf challenge Name: Company: Address: Phone: Email: I would like to register for (number) people at $120 per player I would like to register (number) team/s at $480 per team Please return this completed form Please accept my payment for the amount of $ by Friday, 1 April to Fleur Bigg: My cheque made payable to the Leukaemia Foundation of Queensland is enclosed Email: email@example.com Please charge my credit card Fax: 07 3318 4444 Type of card (circle) Visa / Mastercard / Amex / Diners Mail: Leukaemia Foundation GPO Box 9954 Card number:_ _ _ _ / _ _ _ _ / _ _ _ _ / _ _ _ _ Expiry date: _ _ / _ _ Brisbane, Qld 4001 Name on card: Payment to be received within Signature: Date: seven days of form being returned. Electronic banking BSB – 064 107 Account number – 009 046 30 PLAYER 1 (captain) PLAYER 2 Email: Email: Attending post golf: Yes/No Attending post golf: Yes/No Handicap Handicap PLAYER 3 PLAYER 4 Email: Email: Attending post golf: Yes/No Attending post golf: Yes/No Handicap Handicap Note: Players without a registered AGU handicap will receive maximum golf handicap – men’s 18 and women’s 27. If you do not have a team of four players you will be grouped with other golfers by Pacific Golf.
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