2017 US Open Entry Form

ENTRY FORM 

2017 ISPS Handa US Blind Golf Open Championship

April 6-10 

Torres Blancas Golf Course

Green Valley Arizona

PLAYER INFORMATION:  

Name:

Address:

 

City, State:                                                                               Zip:

    
  
 
 

Country:                                                          Tel No:

    
 
  

Cell No:                                                          E-mail:

    
 
  
 

COACH’S NAME:                                                                    E-mail:

    
 
  
 

SHIRT SIZES:  please put an x before the appropriate size:

Player:  (  ) S (  ) M (  ) L (  ) XL (  ) XXL, (  ) XXXL   ­(  ) men’s  (  ) women’s

Coach:  (  ) S (  ) M (  ) L (  ) XL (  ) XXL (  ) XXXL   ­(  ) men’s  (  )women’s

CURRENT IBGA HANDICAP: 

(note: players participating in this tournament must have an IBGA handicap.)

Please place an x before the appropriate selection 

SIGHT CATEGORY:      (  ) B1          (  ) B2                (  ) B3

I want to play a practice round on Friday April 7    (  ) Yes   (  ) No

My coach wants to play a practice round on Friday April 7

 $35.00 payable to the pro shop:  ­(  )Yes   (  )No

ACCOMMODATIONS:

All the rooms at the Best Western Hotel have two queen sized beds.

Arrangements for additional nights, before April 6 or after April 9, are to be made directly with the hotel indicating that you are with the United States Blind Golf Association. 

Do you or your coach have any special dietary needs?

Number of additional guests attending welcome dinner ($15)   #               total $

Awards Dinner Choices:

(  )       Baked Salmon

(  )       Beef Stroganoff

(  )       Chicken Piccata

(  )       Pasta Primavera          

Number of additional guests attending awards dinner ($25)        #                 total $

Do you have a guide dog?

PLEASE NOTIFY US AS SOON AS POSSIBLE IF YOU MUST CANCEL!

TRANSPORTATION:

I will provide my own transportation   (  ) yes  

I am interested in transportation being provided (  ) yes

I accept the conditions of this entry as set forth in the information letter provided.

Signature:                                                                                                Date:

 

The $150 registration fee plus additional guest dinners, must accompany this form.  Make checks or money orders payable to The United States Blind Golf Association (USBGA) in US dollars.

Mail to:

USBGA

Dick Pomo

932 W. Bosch Dr.

Green Valley, AZ 85614. 

Return this form before February 1, 2017