Last Name
First Name		 METHOD OF PAYMENT

CASH              
CREDIT CARD
CHEQUE         

DATE OF APPLICATION


NAME ON CC (IF APPLICABLE)

Home Address

Business Address

Business Phone                         Home Phone

Mobile                                     Fax:

Email Address
FAMILY INFORMATION
   Spouses Name
  Child's Name 
  Child's Name
  Child's Name

As a member of the Cable & Wireless National Golf Academy, I agree to abide by all it's  RULES AND REGULATIONS..