Download a registration form - 2011 charity golf challenge

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					         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:   fbigg@leukaemia.org.au
   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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