ENTRY FORM / Official AL-MS District Qualifying Tournament for the
2017 Optimist International Junior Golf Championships

TOURNAMENT INFORMATION

District: Alabama-Mississippi

Date: Monday and Tuesday, June 12 & 13, 2017

Location: Lagoon Park Golf Course, 2855 Lagoon Park Dr

Montgomery, AL 36109-1112, (334) 271-7000

Divisions Offered: Boys: 10-11 Boys: 12-13 Boys: 14-15 Boys: 16-18

Girls: 10-12 Girls: 13-14 Girls: 15-18

Entry Fee: Early Registration (DEADLINE MAY 27, 2017 (must be received on this date1)), $100.00

Regular Registration (DEADLINE JUNE 7 2017 (must be received on this date2)), $120.00

Make checks payable to “ALMS Optimist District.” Do not send cash)

Contact Person: John Varnado: Cell 334.467.1640 Home 334.277.3146 Email:

Pre-qualifying requirements: None

Notes: Entry fee includes green fees for two days, bucket of range balls, lunch buffet both days, and goodie bag.

1 Must be received and paid in full by this date. NO EXCEPTIONS

2 Onsite registration allowed -- $130.00.

***** Cut on Dotted Line Above and Return This Section *****

Circle Appropriate Division: Boys: 10-11 Boys: 12-13 Boys: 14-15 Boys: 16-18

Girls: 10-12 Girls: 13-14 Girls: 15-18

PERSONAL INFORMATION (PLEASE TYPE OR PRINT LEGIBLY
Golfer's Name: / Birthday (cannot turn 19 on or before June 16, 2017):
Address: / City, State, Zip:
Parent(s) Name(s): / Home Phone:
Parent(s) Work/Cell Phone: / Email:

WAIVER STATEMENTS

I certify that I am an amateur player according to the rules of the USGA and that all of the information furnished is true to the best of my knowledge
Golfer's Signature: / Date
In consideration of my child's participation in the Optimist Junior Golf qualifying tournament I hereby release the sponsor from any and all liability resulting from any accidents that might occur while he/she is participating.
Parent's Signature: / Date:

RETURN INFORMATION:

Please complete this form in its entirety, enclose appropriate registration fee as a check or money order. (Make payable to ALMS Optimist District”. Do not send cash)

Send to: John Varnado, AL-MS District Junior Golf Chairperson

3003 Pinehill Road

Montgomery, AL 36109 Sponsoring Optimist Club/Business: ______