MONTHLY CLINIC

First Name (required)

Last Name (required)

Date of Birth (for Gate Security)

Driver's License Number

Driver's License State

Email (required)

Zip Code

Role (Select All That Apply)
Adaptive GolferAble-Bodied GolferVolunteerSponsorFirst Time

Do you need adaptive equipment to participate?
YesNo

Are you a Veteran?
YesNo

Will you be staying for lunch? (Sponsored by Gateway Mortgage)
YesNo

Lunch Selection
NoneChicken WrapCheeseburgerHot DogVeggie Wrap

Side Selection
NoneChips

Select month you will attend.
AugustSeptemberOctoberDecember

READ THE PHOTO RELEASE TERMS AND LIABILITY WAIVER FORMS.
You will not be able to finish registration without agreeing to the photo release and liability terms.

I agree to the Photo Release terms.

I agree to the Liability Waiver terms.