Ontario Medical Student Bursary Fund Golf Tournament Registration Form

 
 

ONTARIO MEDICAL STUDENT BURSARY FUND
(OMSBF)
13th Annual
Fundraising Golf Tournament

REGISTRATION FORM

Friday May 26, 2017 - 7:45 AM Shotgun Start

Eagles Nest Golf Club
10,000 Dufferin Street,
PO Box 403, Maple, ON
L6A 1S3

Salutation:

Mr.   Mrs.   Ms.   Dr.

OMA Number:

First Name:

Last Name:


Address:


City:

Province:  Postal Code:

Work Telephone:

( ) -

Home Telephone:

( ) -

Email Address:


Golfing with:

NameContact PhoneE-mail


Fees:

All packages include: 18 holes of golf with cart, breakfast, lunch, golf contests.

  Rate # Quantity $Total
Golfer Package $500
Foursome Package $2,000
Lunch only Ticket $75
TOTAL 
Please note that partial tax receipts can only be issued to those who make payments directly to the Ontario Medical Student Bursary Fund (OMSBF)

Please indicate any special dietary requirements:



Payment Information:
If paying by cheque please make payable to:

Ontario Medical Student Bursary Fund
150 Bloor St W., Suite 900
Toronto, Ontario
M5S 3C1

All proceeds fund student bursaries through the OMSBF

For more information: contact Cheryl D'Souza or Mindy Webber at omsbf@oma.org
Toll Free 1-800-268-7215 x 2985 or x 2259, Local 416-340-2985

Web http://www.omsbf.org/

Payment Method:     Cheque   or      Visa   or     MasterCard

Card Number:

(no spaces)        Card Expiry:

Card Holder Name: