36th EAGA Eastern Regional Amputee & Adaptive Golf Championship

36th EAGA Eastern Regional Amputee & Adaptive Golf Championships

CHAMPIONSHIP ENTRY FORM

Tournament - July 23rd, 24th, & 25th, 2023

Scramble - Sunday, July 23rd, 2023

Saucon Valley Country Club, Bethlehem, PA

Registration Deadline is July 5th, 2023

Player Information

Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Spouse / Guest(s)

E-mail*

example@example.com

Phone Number*

Birthdate

Date

USAGA Sport Classification

Amputation

Other Disabilities

GHIN Handicap (or average score for 18 holes) *

Guest(s) GHIN Handicap (or average score 18 holes)

Flight Division?*

Will you be a Full Tournament or Scramble ONLY Participant or Both ?*

Requested Partner(s) for Sunday Scramble

EAGA Member ?*

EAGA Membership Type*

Comment or Requests:

Veteran

Branch

Rank

Payments are processed through PayPal. You may pay using an existing PayPal account, or any major credit card / debit card.

Tournament Fees:

Sunday Scramble Event (ONLY) Fee for EAGA Member (Amputee or Associate) Sunday July 23rd (only). Includes: Green fees / 1/2 Cart / Deluxe Box Lunch / Sunday BBQ / Awards / Prizes / Hospitality

$195.00 Quantity
Item subtotal:$0.00

Sunday Scramble Event (ONLY) Fee for Non - Amputee GuestSunday July 23rd (only). Includes: Green fees / 1/2 Cart / Deluxe Box Lunch / Sunday BBQ / Awards / Prizes / Hospitality

$210.00 Quantity
Item subtotal:$0.00

Sunday - Dinner Meal Fee per Non-Golfing Guest (Optional) Sunday, July 23rd

$44.00 Quantity
Item subtotal:$0.00

Tournament Entry Fee for EAGA Member (Amputee or Associate Participant)Monday, July 24th and Tuesday, July 25th. Includes: Green fees / 1/2 Cart / Monday Buffett Dinner / Tuesday Awards BBQ / Prizes / Hospitality

$330.00 Quantity
Item subtotal:$0.00

Tournament Entry Fee for Non - Amputee GuestMonday, July 24th and Tuesday, July 25th. Includes: Green fees / 1/2 Cart / Monday Buffett Dinner / Tuesday Awards BBQ / Prizes / Hospitality

$345.00 Quantity
Item subtotal:$0.00

Monday - Buffet Dinner Fee per Non-Golfing Guest (Optional)Monday, July 24th

$48.00 Quantity
Item subtotal:$0.00

Tuesday - Awards Buffet Fee per Non-Golfing Guest (Optional)Tuesday, July 25th

$27.00 Quantity
Item subtotal:$0.00

EAGA Amputee MembershipMust be a 2023 Paid Amputee Member to participate in Eastern Regional

$15.00

Total

$0.00

Payment Methods

Debit or Credit Card

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info