ENTRY FORM
ENTRY # ____________
DATE RECVD ________
AMT RECVD _________
DISTRICT 4 GOLF TOURNAMENT
2 PERSON BEST-BALL
JUNE 11th (1ST TEE TIME – 9:30AM)
3 RIVERS GOLF COURSE
PLAYER INFORMATION
(PLEASE PRINT CLEARLY)
PLAYER NAME __________________________ PLAYER PARTNER ______________________________
OTHER PLAYING GROUP (IF KNOWN) _______________________ _________________________
HOME ADDRESS ________________________________ PHONE __________________
CITY _____________________ STATE ________________ ZIP ___________________
CARTS ARE THE RESPONSIBILITY OF EACH GOLFER
COURSE PHONE IS 360-423-4653
ENTRY FEE (DOES NOT INCLUDE CART): $53.00 PER PERSON
MAKE CHECKS PAYABLE TO: COWLITZ VALLEY MOOSE # 530
MAIL COMPLETED ENTRY FORM, COPY OF USGA HANDICAP CARD, MOOSE CARD, AND PAYMENT TO:
COWLITZ VALLEY MOOSE #530
921 WASHINGTON WAY
LONGVIEW, WA 98632
ENTRY FORMS AND FEES MUST BE RECEIVED BY MAY 28, 2011
FOR INFO OR QUESTIONS: TIM NELSON 360-431-2939
RELEASE
The undersigned, by virtue of my signature, hereby apply for entry into the Cowlitz Valley Moose #530 Golf tournament.
In consideration of the acceptance of my application to enter the Cowlitz Valley Moose #530 Golf Tournament, I hereby waive release, and discharge from any and all claims for damages, death, personal injury, or property damage which I may have, or which may subsequently occur to me as a result of my participation in the Cowlitz Valley Moose #530 Golf Tournament: Moose International, The Washington/North Idaho Moose Association, Cowlitz Valley Moose Lodge #530, and their respective agent(s) and employee(s) from and against any and all liability arising out of, or connected in any way with my participation in this golf tournament.
The terms hereof shall serve as a release and assumption of risk for my heirs, executors, administrators, and assigns in exchange for my participation in the Cowlitz Valley Moose #530 Golf Tournament.
FURTHERMORE, I hereby attest and affirm:
1. That I am at least 21 years of age.
2. That I have read the Cowlitz Valley Moose #530 Golf Tournament rules and agree to abide by them.
3. That I posses no physical disabilities which may limit or prevent my participation in the Cowlitz Valley Moose #530 Golf Tournament except as detailed below (if none, please write “NONE”):
_______________________________________________________________________________________________________________________________________________________________________________________________________________
GOLFER LISTED MUST COMPLETE AND SIGN BELOW
SIGNATURE ______________________________________
PRINTED NAME ____________________________ SEX: M F
MOOSE ID NUMBER ______________________ DATE OF BIRTH ________
LODGE NAME ________________ NO. _______ CITY _________________
GIN/USGA HCP__________ AVERAGE SCORE (IF NO HCP ESTABLISHED_________
DATE SIGNED _________________________