You must have JavaScript enabled to use this form. Member Info Name * PDGA Number * Email * Phone Which rules or regulations are you requesting an exemption from? * What is your proposed modification to the rules that will allow you to better participate in PDGA-sanctioned events? * Describe the condition(s) that are the basis for your reasonable modification request. * Provide specifications for any mobility device or assistive technology you intend to use under the proposed modification. Example: if you are using a motorized device, you can provide a URL for the manufacturer’s web page with information about the model of device you wish to use. Supporting DocumentationPlease attach a letter or note from your physician confirming that your condition(s) necessitate the proposed modification. Physician Statement * Please attach a letter or note from your physician confirming that your condition(s) necessitate the proposed modification.Files must be less than 256 MB.Allowed file types: gif jpg jpeg png pdf. Signature * By submitting this form, you certify that the information you’ve provided above is true and correct to the best of your knowledge, and that you understand that falsifying information on this form may lead to disciplinary action. You further certify that you have read, understood, and agreed to the terms of the Reasonable Modification Request Policy for Exemption from PDGA Rules, Regulations, and Procedures
