ARKANSAS STATE GOLF ASSOCIATION
MIXED TEAM CHAMPIONSHIP
October 4-5, 2003
Red Apple Country Club
Heber Springs, AR

Entry Fee: The entry fee is $100 per person or $200 per team. 
ENTRY DEADLINE - Entry must be received by 5:00 p.m., Friday September 19, 2003.
(Late or incomplete entry not accepted-- Please do not fax or telephone.)
Mail application and entry fee of  to:
ARKANSAS STATE GOLF ASSOCIATION
#3 Eagle Hill Court, Suite B
Little Rock, AR  72210
or Sign-up Below Electronic.

Please Enter the Team Listed Below in the 2002 ASGA Mixed Team Championship
Sat. Tee Time Request       

Name      Players Club Number
Home Address       Handicap Index
City      Zip Code
Telephone #        E-Mail Address  
ASGA GHIN Number    Member of Club
PARTNER: (Partners do not have to be husband and wife or members of the same club.)
Name         Players Club Number
Home Address Handicap Index
City     Zip Code
Telephone #             E-Mail Address 
ASGA GHIN Number    Member of Club

Name of Person on Credit Card
We understand that our entry is subject to rejection at any time (including during the Championship) by the ASGA or the host Club.  The reason for rejection may include unbecoming conduct.  Any questions shall be settled by the ASGA, whose decision is final. We hereby acknowledge that the Arkansas State Golf Association and the host club are not responsible for personal injury during this Championship.  We have read the ASGA Rules of Amateur Status and we conform with those rules in every way.

APPLICANT'S SIGNATURE   DATE 
APPLICANT'S SIGNATURE   DATE