MEMBERSHIP APPLICATION

Name: _________________________________________

Address: _________________________________________

_________________________________________

Postal Code: _______________

Phone: (H) ____________________ (B) ___________________

Fax _________________ Email ____________________

Amputee - BK__ AK __ BE__ AE __ DBL __ TRP__ QUAD ___

I would be interested in being involved. (Indicate how) ___________________________________________

_________________________________________________________

_________________________________________________________

Membership Fee is Currently $25.00 ANNUALLY, $150 LIFETIME

I would like to make a further donation to
the association ($ ________ enclosed)

Mail your "new and renewal memberships"
(along with your cheque or money order) to:

Secretary/Treasurer
C.A.G.A. (Canadian Amputee Golf Association)
P.O. Box 6091
Station A
Calgary, Alberta
Canada
T2H 2L4

For further information, email canamps@caga.ca