Competitor Name (BLOCK Letters) (First Name) (Surname) Mailing Address Suburb // Date of Postcode (Compulsory) Home Phone Mobile Phone Email Home Club GOLFLink GA Handicap Number Amputee Elbow Below Elbow Above Knee Below Knee Multi Other Status Amputee Golf Q.A.G.A A.G. NSW A.G Vic S.A A.G.A Please Specify Association Please circle All events you will be attending Sat 15th Sun 16th Sun 16th Sun 16th Events Round 1 Round 2 Pres. Dinner Pres Dinner Only Size S M L XL XXL 3XL 4XL Please Specify Amputee Entry Fee: Includes two Rounds of Golf, Lunch & Presentation Dinner; $100 Please use your name as a reference when using Electronic Funds Transfer. Forward Payment to Queensland Amputee Golf Association; BSB 034-604 Acc No. 220 894
Competitor Name (BLOCK Letters) (First Name) (Surname) Mailing Address Suburb Postcode Date of (Compulsory) // Home Phone Mobile Phone Email Home Club GOLFLink Number GA Handicap Amputee Status Elbow Below Elbow Above Knee Below Knee Multi Other Amputee Golf Association Q.A.G.A A.G. NSW A.G Vic S.A A.G.A Please Specify Events Round 1 Round 2 Pres. Dinner Pres Dinner Only Please circle All events you will be attending Sat 15th Sun 16th Sun 16th Sun 16th Size S M L XL XXL 3XL 4XL Please Specify Amputee Entry Fee: Includes two Rounds of Golf, Lunch & Presentation Dinner; $100 Please use your name as a reference when using Electronic Funds Transfer. Forward Payment to Queensland Amputee Golf Association; BSB 034-604 Acc No. 220 894