1102 First Avenue South, Conover, North Carolina 28613
Phone: 828-465-4693 Fax: 828-465-4693
E-mail: tomtour2000@charter.net Website: www.theuga.com
Name:________________________________________________________________
Address: ________________________________________________ City: ________________________________ State: ______ Zip: _________________
E-Mail: _________________________________________________ Home Phone:_______________________ Alternate phone: _____________________
Visa/Mastercard #: _______________________________ Expires: _______________ USGA Handicap or Index: _______
Club Affiliation: __________________________ Club phone: _____________________________
Name and phone # of person to be contacted in case of emergency
Contact: _____________________________ Relationship: ________________ Home phone:________________ Alternate phone: ____________________
Optional Bio
Place of Birth: ____________________________ Height: ________ Weight:________ Date of Birth: ___________________________
Wife: _______________________________ Children:_______________________________________________________________
Favorite Ball: __________________ Favorite Club: ____________________________
I hereby apply for membership in The UGA Amateur Division. I understand that my application is subject to the approval of The UGA Amateur Division (UGA) in its sole discretion and that it may be rejected without liability at any time, provided however, that all applications shall be accepted and consideration given for entry in the order received without regard to race, religion, color, martial status, gender ancestry, or national origin.
I agree to abide by the policies and procedures of The UGA Amateur Division as amended or supplemented from time to time. I expressly agree to assume all risks associated with the tournament play and to hole harmless The UGA, the hosting golf course, and their officers, directors, employees, and agents from any and all claims or causes of action, including attorneys’ fees and court costs, on account of any injuries or damages I may sustain or cause in connection with such tournament(s).
In consideration of The UGA’s approval of my application for entry, I expressly grant and assign to The UGA the right to use my name, personal likeness, voice and autobiographical material in connection with advertisements, promotions, and publicity for The UGA Amateur Division and the tournament(s).
_______________________________________________
Signature
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