ENTRY FORM

NOMADS GOLF CLUB GAUTENG

e-mail address: gautengnomads@cqnet.co.za

P.O. Box 35244 NORTHCLIFF 2115

CELL: 083 442 0904 FAX: 08654 00610

GLENDOWER GOLF CLUB / VOLVO MASTERS WEDNESDAY 22nd MAY 2013

BADGE NAME: MY CURRENT HANDICAP AT IS SHOWN AS DO YOU WISH TO PLAY IN THIS MATCH?
DATE ENTERED:

YES NO

MATCH FEES & METHOD OF PAYMENT

Due to safety reasons, CASH payments on the day of play

WILL NO LONGER BE ACCEPTABLE

Please mark the appropriate payment box with an "X"
1 2 CHEQUE CREDIT CARD Card Number: Expiry Date: CCV NUMBER: SIGNATURE: 3 ELECTRONIC TRANSFER R 190.00 [ Month ][ ][ Year ] LAST 3 DIGITS ON THE BACK R 190.00 R 200.00

NB. Only "VISA" and "MASTERCARDS" are accepted

NB . Please fax a copy of the electronic transaction

Bank details:NEDBANK-Business West Rand (128605) ACC: 1286084768 4 YEARLY PAID Prepaid

I CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND CORRECT

Should no form of payment be made, you may not be included in the field!!! Entries will close as soon as we have a full field, so return your entry form a.s.a.p.

NB: NO REFUND ON GAME WILL BE MADE AFTER TIME SHEET HAS GONE OUT.