Registration/payment for UHCA Fall Golf Classic

Utah Health Care Association presents the Annual UHCA Fall Golf Classic.

Please use the form below to reserve your golf entry.

Please register as SOON AS POSSIBLE as we have set number of tee times reserved and will not be allowed to exceed this allotment. Please note that payment must accompany all entries.

First Name*

Last Name*

Facility/Business*

Address*

Address2

City*

State*

Zip*

Phone*

Fax

Email*

Other Comments

Team Members Request*

Indicate number of players you are paying for ($150/each)*

*Cancellation of Registration 90 days prior to Event is entitled to a Full Refund, One Month prior to the Event is half a refund and anything 30 days or less will be NO Refund.

Total Amount

Payment method *

Credit Card via Authorize.net
Mail Check / No Payment Due

Billing Zipcode*

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Type*

Card Holder Name*

Verification code*