Corner of S. 129th E. Ave. & E. 121st
2 Blocks South of Creek Turnpike- Olive Exit
Broken Arrow, Oklahoma

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Camp / Lesson/ Membership Registration Form

Today's Date _____/_____/ _____                                 Member #___________

 

Golfer's Name ______________________________________________  male/ female (circle one)

         Adult         Junior         Pee Wee        Super Senior  (circle one)

               
                Age________ Birthday: _____/ _____/ _____

                School___________________________ Grade____________

Address_____________________________________________

City_________________________ ST_______ Zip___________

Home Phone: (____) _________________

Business Phone: (____) _________________

Cellular Phone: (____) _________________

Email Address: ____________________________________

 

Information below must be filled out for Junior Golfers:  

Mothers Name______________________________________     Address_____________________________________________     City_________________________ ST_______ Zip___________     Home Phone: (____) _________________     Business Phone: (____) _________________     Cellular Phone: (____) _________________     Email Address: ____________________________________ If information is the same, just write same

Fathers Name______________________________________     Address_____________________________________________     City_________________________ ST_______ Zip___________     Home Phone: (____) _________________     Business Phone: (____) _________________     Cellular Phone: (____) _________________     Email Address: ____________________________________ If information is the same, just write same

OR       

 Guardians Name__________________________________

Relationship to Golfer____________________________________

Address_______________________________________________

    City_________________________ ST_______ Zip___________

    Home Phone: (____) _________________

    Business Phone: (____) _________________

    Cellular Phone: (____) _________________

    Email Address: ____________________________________

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