ARKANSAS STATE GOLF ASSOCIATION
15TH SENIOR MATCH PLAY CHAMPIONSHIP
EAGLE HILL GOLF CLUB
LITTLE ROCK, ARKANSAS
MAY 20-23, 2002

ENTRY DEADLINE- Entry must be received by 5:00 p.m. Friday, May 9 , 2003.

The entry fee is $75 per player for ASGA Members.

Name        Age   Date of Birth 
Address    Handicap Index  
City           Zip Code 
Phone         E-Mail Address 
I am an individual member of   GHIN Number
ASGA Players Club Member ID Number   

Credit Card Type           
Credit Card Number      
Expiration Date       Mo     Year
Name on Card                
Amount Submitted           

I understand that my entry is subject to rejection at any time (including during the Championship) by the ASGA or the Eagle Hill Golf Club.  The reason for rejection may include unbecoming conduct.  Any questions shall be settled by the ASGA, whose decision is final.  I hereby upon submitting this entry, that the ASGA and the Host Club are not responsible for personal injury during this championship  I have read the USGA Rules of Amateur Status and conform with those rules in every respect.

Please Print the Confirmation Page to Confirm Your Entry Form was received by the ASGA.  This Does Not Mean Your are Entered in the Tournament.