2011 Junior World Golf Qualifier

May 31, 2011

USJGT

Junior World Qualifier

Marion Golf and Athletic Club

Marion, Arkansas

Cost : $50 (USJGT members); $75 non-members

PLAYER’S NAME__________________________________________M/F________

Division Entering (Please circle one) - Based on age as of July 14, 2011

                                                                 For Boys/Girls age 15-17 - age as of July 15, 2011

Boys 15-17   Girls 15-17   Boys 13-14   Girls 13-14   Boys 11-12    Girls 11-12

Boys 9-10     Girls 9-10     Boys 7-8     Girls 7-8

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______________________________________________

USJGT

4060 Walnut Grove Rd.

Memphis, TN  38117

(901) 212-0606 –Phone

(901) 821-0321 - Fax