FootGolf Course Operator Enrollment

Course of Company Name*

Address (no PO Box)*

Street Address City Province Postal Code

Phone*

Fax

Website

Primary Contact

Name*

First Last

Mobile*

Email*

Mailing Address if Different From Above

Street Address City Province Postal Code

Preferred Method of Communication*

Course Details*

Ownership Information*

Method of Payment*

Rate for 2015 Season*

Total

$ 0.00 CAD

Credit Card*

American Express

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name