Membership Form

Blind Golf Canada 2017 Membership Form

Please forward your $25 membership fee to:

Blind Golf Canada

C/o Boyde Stewart

451 Highway 336,

Upper Musquodoboit, Nova Scotia

B0N 2M0

The deadline for membership dues is March 31st, 2017. Any dues paid after this date will be classified as a new member with no voting privileges until the following year

Player's Name: ………………………………………..

Street Address: ……………………………………….

City: ………………………… Province: ……………. PC: ………………..

Email: ……………………………………..

Primary Phone: …………………….. Cell Phone: ……………………………

Gender: (Please Circle) Male  Female

Date of Birth ………………………

Sight Category:  (Please circle) B1 B2 B3 B4

Your eligibility toward holding membership status within Blind Golf Canada is determined by Legal blindness; defined as 20/200 or worse in the better eye with best correction, or having a field of vision that is less than 20 degrees in the better eye. Holding membership within BGC does not automatically entitle you to partake in all tournaments sanctioned and hosted by BGC and/or the IBGA. (See IBGA and BGC Bylaws as they pertain to sight categories and participant's eligibility.)

***Note: If you are a first time or new member applying for membership within Blind Golf Canada, your membership form and $25 cheque must be accompanied by an eye report from your Optometrist or Ophthalmologist (not older than two years or, a photocopy of your current and valid CNIB identification card.

I understand that Blind Golf Canada and/or the IBGA maintains the right to request any additional sight verification at any time and/or prior to participation in specific tournaments.

Member's Signature …………………………………………..

 

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