ON-LINE ENTRY FORM

Please provide the following contact information:

	Name
	Street Address
	Address (cont.)
	City
	State/Province
	Zip/Postal Code
	Home Phone
	Cell Phone
	E-mail
To Compete for the Super Senior event you must be 65 Years or older on or before October 16, 2007	I am eligible to compete in the Super Senior	Yes No
A current GHIN or IGN handicap MUST accompany this entry.	GHIN #
	IGN #
	Name of club authorizing handicap:
	Please UPDATE National, Regional and/or State Golf titles or honors you hold:
	Please list email address of your local newspaper:

 By clicking on the submit button below, I agree to the following:

• I agree that there are certain risks inherent in the game of golf and accept personal and sole responsibility and liability for such risks, whether anticipated or not.
• I agree that the Women's Eastern Golf Association (WEGA) reserves the right to photograph participants in and at WEGA Championships. These photographs
  may be used in conjunction with WEGA promotions including publications and/or the WEGA Webite at no charge to WEGA.
• I agree that this entry is subject to rejection at any time (including during the Championship) by WEGA.  The reason for rejection may include without limitation, unbecoming conduct, incorrect and/or incomplete information.
• I agree and understand that this on-line entry form will not be considered complete until full payment is received.

**** Please make check payable to Women's Eastern Golf Association
and send entry fee of $100.00 to Suzanne Nelson:  106 Tall Oak Lane, Flat Rock, NC  28731   ****