Please Print  

USBGA Application Form

Today's date: _____________________________________

Circle one:     Totally Blind       Vision Impaired       Support

Name:              ______________________________________________________

Address:          ______________________________________________________

City/State/Zip: ______________________________________________________

Home Phone:   _______________________           Work Phone:  _________________

Fax: _______________________ Email: _________________________________

Date of Birth: ______________________

Date and cause of blindness ____________________________________________

Handicap/Index (if available)___________________________________________

Please mail completed form to:

United States Blind Golf Association

President Phil Blackwell

18 Barnwood Circle

Greenville, SC  29607

PLEASE NOTE:  Totally blind division requires two different and unrelated USBGA/IBGA Sight Classification Forms. Vision Impaired only require one.

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