14th ARKANSAS STATE GOLF ASSOCIATION SENIOR & SUPER SENIOR CHAMPIONSHIP June 18-20, 2002 Pine Bluff Country Club Pine Bluff, Arkansas

ENTRY DEADLINE - Entry must be received by 5:00 p.m., Wednesday,   June 5, 2002.

The entry fee is $140 per player or $115 per player for ASGA Players Club Members.  ASGA Players Club Members pay annual dues of $50 to receive $25 discounts on certain ASGA Sponsored Championships as well as other benefits.

Name            Age     Handicap Index
Address        Daytime Phone Number
City               Zip E-mail Address
I am a member of Club or Golf Association   GHIN Number
Member of the ASGA Players Club Yes    No   If Yes, Players Club I.D. #     

Check One
  Enter me in the Senior Flight (Ages 55-64)
  Enter me in the Super Senior Flight (Ages 65 & Over)
  Enter me in the Masters Division (Ages 75 & older)

My date of birth is 

Credit Card Type       DISCOVER CARD VISA MASTERCARD
Credit Card Number  
Expiration Date          
Name on Card           
Amount Submitted    

The entry fee includes the cart fee for all three tournament rounds.

I am a member in good standing with the Arkansas State golf Association & member course listed above.  I agree that my entry is subject to the rejection at any time (including during the championship) by the ASGA.  USGA rules govern all play.  Any disputes will be settled by the ASGA, whose decision is final.  I herby upon submitting this entry agree to waive all claims against the Arkansas State Golf Association and Pine Bluff CC for personal injury or death as a result of any actions in relation to this championship.  I have read the USGA rules of Amateur Status and I conform with those rules in every Respect. 

Please print the confirmation page after submitting this form.  This does not mean that you are in the tournament only that the ASGA has received your entry form and for your records.