May 26, 2009
USJGT
Marion Golf and Athletic Club
Marion, Ark.
Cost: USJGT Member: $50, Non-member: $75
PLEASE DO NOT ENTER IF YOU DO NOT PLAN ON ACCEPTING INVITATION TO SAN DIEGO
PLAYER’S NAME__________________________________________M/F________
Age of Player on July 17, 2008 ____________________________________________
STREET ADDRESS______________________________________________________
CITY, STATE, ZIP_______________________________________________________
E-MAIL (Please print clearly)______________________________________________
PHONE________________________________________________________________
We accept Visa and Mastercard only:
Billing Information
Name as it appears on card________________________________________________
If billing address is same as above, check here____________
If different, please fill out below:
Billing Adress___________________________________________________________
City, State, Zip__________________________________________________________
Card Number: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Expiration Date______________________________________________
If paying by check, mail to address below.
If paying by credit card, mail to address below or fax it to (901) 821-0321
USJGT
4060 Walnut Grove Rd.
Memphis, TN 38117
(901) 212-0606 –Phone
(901) 821-0321 - Fax
