Team Captain:

First Name* (required)

Last Name* (required)

Address* (required)

City* (required)

Province* (required)

Postal Code* (required)

Phone Number* (required)

Email

I consent to receive electronic communications from Nikkei Place Foundation (on behalf of Nikkei Seniors Society). You may withdraw your consent at any time by contacting creative@nikkeiplacefoundation.org

Golfer 2:

First Name

Last Name

Address

City

Province

Postal Code

Phone Number

Email

I consent to receive electronic communications from Nikkei Place Foundation (on behalf of Nikkei Seniors Society). You may withdraw your consent at any time by contacting creative@nikkeiplacefoundation.org

Golfer 3:

First Name

Last Name

Address

City

Province

Postal Code

Phone Number

Email

I consent to receive electronic communications from Nikkei Place Foundation (on behalf of Nikkei Seniors Society). You may withdraw your consent at any time by contacting creative@nikkeiplacefoundation.org

Golfer 4:

First Name

Last Name

Address

City

Province

Postal Code

Phone Number

Email

I consent to receive electronic communications from Nikkei Place Foundation (on behalf of Nikkei Seniors Society). You may withdraw your consent at any time by contacting creative@nikkeiplacefoundation.org

Payment and Contact Info:

As we are unable to accept online payments at this time, please leave your contact information and our office will follow up regarding roster details and payment after we receive your registration request.

First Name* (required)

Last Name* (required)

Phone Number* (required)

Email