2021 – Ladies Academy Registration Form

2021 Ladies Clinic Registration

Participant Information
Name of Participant*
First Last
Date of Birth*
Any Medical Conditions
Dietary Requirements:
Contact Email*
Phone Number:*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Introducer and Emergency Contacts
Name of Introducer (RQ Member)*
First Last
Emergency Contact
First Last
Emergency Contact Phone
Enrolment
Enrolment*
Please select which term(s) you would like to enrol in. Hold down the Ctrl button to select multiple options.
Photography / Video Permission:
Photography / Video Permission:*
- I give my consent to:
- I do not give my consent to:
the participant above being photographed or filmed on video camera for coaching and publicity purposes associated with Ladies Golf at Royal Queensland Golf Club

Participant Information