Address     City   Zip Code 

Email        Phone    Home Club 

Partner
Name     Handicap Index    ASGA GHIN Number (required)

Address     City   Zip Code 

Email        Phone    Home Club 

Date Applied

               We understand that our entry is subject to rejection at any time (including during the Championship) by the ASGA Women’s
                Committee or the host Club.  The reason for rejection may include unbecoming conduct.  Any questions shall be settled by the
                ASGA Women’s Committee, 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 USGA Rules of Amateur Status
                and we conform with those rules in every respect.