2012 WEGA Amateur Championship Entry Form

Please fill out the following information and click the "SUBMIT" button at the bottom of the page to send in your entry form.   When you click the "SUBMIT" button, you will automatically be directed to the PayPal payment page where you can complete you entry payment on-line. If you prefer to pay by check: Highlight the completed form, print a copy and mail the entry form and a check for $215.00 payable to  WEGA to : Carol Haas 12 Rockford Mews Court Wilmington, DE 19806 302 981 5819 (M) YOUR ON-LINE ENTRY IS NOT CONFIRMED UNTIL YOUR PAYMENT AND HANDICAP INFORMATION HAS BEEN RECEIVED! The field is limited to 80 contestants.  Priority for applications received before the deadline is based on handicap index.  If the field is not full, priority for applications received after the deadline will be based on the postmark date on the envelope.  Notice of acceptance or place on the waiting list will be sent after the deadline.

First Name:
Last Name:
Address:
City:
State:
Zip:
Telephone:
Cell Phone:
Email:
WEGA Member Club or School Name and State
Club and State where handicap is maintained
On-line handicap service (ghin, golfnet) and number
Are you requesting private housing?	Yes No
If yes, date of arrival and roommate preference
Indicate whether you are paying by PayPal or Check	PayPal Mailing Check
Please update any National, Regional and/or State golf titles or honors that you hold:	If none, type "none"
Please list a fax number and/or email address of your local newspaper:
Please list any other information that the Committee should be aware of:

 

If your club has not yet paid WEGA club member dues for 2012, send a $35.00 check payable to WEGA to:

Anne Fraser, WEGA Treasurer
38 Maplewood Road
Lynn, MA 01904

and provide the name of the club and state.

or

click here to pay WEGA club member dues on-line

 

For a listing of Member Clubs

• By this application, I consent to the use by WEGA, or persons authorized by WEGA, of my name, likeness, voice and references to me and photographs and other images of me and my play connected with my appearance in this Championship, or any portion(s) thereof, in connection with publicity for and about this tournament including on the WEGA website.
   

• By this application, I agree that there are certain risks inherent in the game of golf and accept personal and sole liability for all such risks including but not limited to any health-related issues.
   

• 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.
   

• Applicants under the age of 18 must mail a copy of this application signed by a parent or legal guardian indicating agreement to these terms to:

Carol Haas

YOUR ENTRY IS NOT CONFIRMED UNTIL YOUR PAYMENT AND HANDICAP INFORMATION HAS BEEN RECEIVED!