2022 Championship
Exemption Request Form
* Please fill in all required fields
CHAMPIONSHIP EXEMPTION REQUEST
CHAMPIONSHIP EXEMPTION REQUEST
Championship
*
Date Submitted
*
PERSONAL INFORMATION
PERSONAL INFORMATION
First Name
*
Last Name
*
Phone Number
*
Email Address
*
City
*
Province
*
Grad Year
University/College
MEMBERSHIP INFORMATION
MEMBERSHIP INFORMATION
Golf Canada Member Card #
*
Club Affiliation
REASON FOR EXEMPTION REQUEST
REASON FOR EXEMPTION REQUEST
Exemption Category
*
Additional Request Information
GOLFING ACHIEVEMENTS
GOLFING ACHIEVEMENTS
#1 Achievement
#2 Achievement
#3 Achievement
#4 Achievement
#5 Achievement
Other Information
PAYMENT INFORMATION
PAYMENT INFORMATION
Credit Card Number
*
Expiry Date (mm/yyyy)
*
CCV (3-digit code on back of card)
*
Name of Credit Card Holder
*
*
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