2023 Golf Ontario Championship Exemption Form

Championship

Date Submitted

mm/dd/yyyy

First Name

Last Name

Phone Number

Phone

Email Address

City

Province

Grad Year

University/College

Golf Canada Member Card #

Exemption Category

Additional Request Information

Club Affiliation

#1 Achievement

#2 Achievement

#3 Achievement

#4 Achievement

#5 Achievement

Other Information

PAYMENT & CONFIRMATION OF REGISTRATION

Please submit payment ($52+HST) by clicking the SUBMIT button below. A new window will open with an online payment form.

Thank you.

Click on the check box below to receive a copy of your response, which will confirm your registration.

Credit Card Holder Name

If the credit card holder name is different from the registered attendee, please indicate the name below for payment verification:

Send me a copy of my responses