Workers' Compensation Claim Association

ANNUAL WCCA GOLF TOURNAMENT

September 21, 2021

*** Please Note: Carts & Range Balls are included in your Registration ***

Fee Schedule

18 Holes Golf: $125

WCCA Tax ID: 47-3268248

Golf Registration Form

Total Fees (Fee Schedule Above )

Company Name

Contact Name *

First Name

Last Name

Email Address *

Phone Number

(###)-###-####

Address

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

Foursome Preference (feel free to make your own foursome)

First Person

First Name

Last Name

Email Address

Payment Responsibility

Second Person

First Name

Last Name

Email Address

Payment Responsibility

Third Person

First Name

Last Name

Email Address

Payment Responsibility

Fourth Person

First Name

Last Name

Email Address

Payment Responsibility