Registration

Saturday & Sunday, August 10th and 11th, 2019

Completely executed entry MUST BE RECEIVED BY no later than 5 P.M. (CDT) on Monday, August 5th, 2019

ENTRIES BY TELEPHONE, TELEGRAPH, OR FAX ARE NOT ACCEPTABLE

Application for Entry - Entry Fee $135.00

Please fill in every applicable blank or entry may be rejected.

Personal Information

NAME:

ADDRESS:

CITY:

STATE:

ZIP CODE:

E-MAIL ADDRESS:

DATE OF BIRTH:

GHIN NUMBER:

Tournament Options

DECLARE CHAMPIONSHIP FLIGHT

DECLARE SENIOR FLIGHT

RESERVE CART

DO NOT RESERVE CART

Payment Information

NAME ON CARD:

CARD TYPE:

CARD NUMBER:

CARD EXPIRATION:

CSC/CVV:

Credit Card Billing Address (If Different Than Above)

ADDRESS:

CITY:

STATE:

ZIP CODE: