SWAGA - 2009

Southwest Amputee Golf Association

 

Regular memberships are open to any amputee who has anatomically lost a hand or foot at a major joint ... wrist/elbow/shoulder/ankle/knee/hip.

Associate membership is available to anyone who desires to support the Southwest Amputee Golf Association.

To join, simply fill in the following requested information.

Date: ______________

Name:                           

First_______________________________ MI______ Last___________________________________

Spouse's Name:

First_______________________________ MI______Last___________________________________

Address: _______________________________________________________

City, State, Zip: ______________________________________________________________________

 Phone            Home: (       )                                      - Work:  (       )           -

 

**** E-Mail: ___________________________________________________

Type of Amputation: ___________________________________________

Disabled Veteran?     Yes _____     No _____

Date of Birth: ________________________(optional)
 

SWAGA Annual Dues (Regular Member):                $ $10.00                                   _______

Annual Dues (Non-Amputee, Associate Member):        $35.00                                   _______

NAGA membership                                                   $25.00                                   _______

First time NAGA membership                                       $10.00                                    _______

______ Please send information about NAGA and its programs. 

Dues payable in United States dollars.
Make check payable to SWAGA.

Please return this form to:

SWAGA

ATTN: Roy McCoy
502 Quail Creek Dr.    

Round Rock, TX  78664  

                      

                           Call (512) 431-2861 for more information.